مجله علوم پزشکی رازی
سال سی‌ام شماره 1 (پیاپی 227، فروردین 1402)

Today, entrepreneurship education has become one of the most important and widespread activities of foreign universities (1, 2). Meanwhile, the entrepreneurial approach in sports can provide a mechanism for enduring economic crises. Emerging economies provide catalysts for entrepreneurship to emerge (3). Reported that the dimensions and existence of the fitness industry and related jobs are still being considered in order to receive the results of entrepreneurs (4).

Sport provides the necessary ground for the development of entrepreneurship by creating a demand for sports services and goods and creating attractiveness for communities, and entrepreneurship helps the development of sports through sports businesses. And identify an effective structure in the development of sports and based on the goals that exist in various dimensions of sports entrepreneurship, to create effective structures and contexts in the development of sports entrepreneurship (8).
One of these structures is psychological specificity. The importance of the issue is such that various experts and theorists of sociological and psychological issues have a special emphasis on the need to develop entrepreneurship based on the psychological characteristics of individuals and in the age of globalization its role in economic, social and cultural development and ... Countries are considered very important (2).
Another important factor in the development of people's potential is mental health. Mental health refers to a situation in which a person does not have abnormal thoughts, behaviors and behaviors while enjoying life and is able to communicate with others and the effective environment (10). In fact, mental health and its role in the survival of human society indicate the importance of man as a social being (11). Considering the above and the importance and role of entrepreneurship in the country and in sports on the one hand and the use of all psychological and health factors in entrepreneurship, so unfortunately, after reviewing research conducted inside and outside the country, no research was found to examine the role Psychological characteristics and mental health in sports entrepreneurs. Therefore, the researcher seeks to answer the question: what is the role of psychological and mental health dimensions in entrepreneurship education in entrepreneurs in the provinces of West and East Azerbaijan?

The method of the present study was correlational research. The population of this study was all entrepreneurs in West and East Azerbaijan. Due to the lack of organization of this society, 130 entrepreneurs were selected as the available sample. The method of physical research was facial. After explaining the objectives of the research and applying the results to the participants, the researcher-made questionnaire of entrepreneurship education has 16 questions and has a five-point Likert scale (it does not matter at all, it is very important). Personality Traits Questionnaire of Nietzsche et al. (2007) has 95 questions and 8 components of balanced risk-taking (questions 1 to 18), control center (questions 19 to 35), need for success (questions 26 to 50), mental health (questions 51 to 63), pragmatism (questions 64 to 71), tolerance of ambiguity (questions 72 to 82), daydreaming (questions 83 to 89), challenge-seeking (questions 90 to 95). Is based on a Likert scale with 4 options (strongly disagree to strongly agree). And Goldberg Mental Health Questionnaire which has 28 questions and 4 components of physical symptoms (questions 1 to 7), anxiety and insomnia (questions 8 to 14), social dysfunction (questions 15 to 21), depression (questions 22 to 28). Distributed and collected among them.
Finally, the mean and standard deviation were used to describe the data and Pearson correlation coefficient at the level of 0.05 with SPSS software version 26 and path analysis with Smrt-pls software were used to analyze the data.

The results of Pearson correlation coefficient showed that there is a positive and significant relationship between the psychological variables of balanced risk-taking, control center, need for success, mental health, pragmatism, ambiguity tolerance, dreaming and challenging and mental health with the evaluation of sports entrepreneurs training (Table 1). Also, the set of psychological dimensions and mental health have a positive and significant effect on the education of sports entrepreneurs (Figure 1).

The results of the present study showed that psychological components have a positive and significant relationship with entrepreneurship. Entrepreneurs Described as individuals with a center of internal control Successful entrepreneurs believe in themselves and do not attribute success or failure to fate, luck, or similar forces. They also have the characteristic of being able to control the events that take place (13). Also, the need for independence is closely related to the desire for control. Entrepreneurs are generally people who want to do things their own way and find it difficult for others to work. The need for independence means being your own boss, which is one of the strongest needs of entrepreneurs (17). Another controversial feature of other entrepreneurs is the need for success. McClelland in his general theory of the nature of the need for success in entrepreneurs, the four characteristics of individual responsibility, setting goals and achieving these goals through personal effort, balanced risk-taking that is a function of performance skills rather than chance, awareness of results Execution of work and stated decision. He concludes that the intense need for success leads people to engage in entrepreneurial behaviors (17). Risk-taking means accepting and embracing the calculated risks in the business. Risk, whether financial or social or psychological, is an integral part of the entrepreneurial process. Entrepreneurs are able to deal effectively with ambiguous, incomplete, uncertain, unorganized and non-transparent situations and information (13).
One of the characteristics of entrepreneurs is creativity. According to Peter Drucker (1985), the existence of innovation in entrepreneurship is so essential that it can be argued that entrepreneurship does not exist without it and creativity does not work without innovation. Therefore, the resulting creativity and innovation is vital to the survival and success of the company. However, no research has been found on the relationship between mental health and entrepreneurship, given that creativity is a prerequisite for entrepreneurship (18). According to the theory of self-coordination, people who consider themselves worthy are more successful in performing tasks because they act on the knowledge they have of themselves (19). Therefore, mental health seems to play an important role in entrepreneurship.

Despite various efforts in various countries and institutions, global warming has increased, animal species are becoming extinct, the sea level has decreased and the temperature has also fluctuated; therefore, no organization in the current situation can fulfill its mission without environmental concerns. On the other hand, empirical evidence in the field of sports shows that the earth has generously provided all its assets to the athletes, from its unattainable peaks to the raging rivers, forests, springs, and endless oceans, but in the meantime, the athletes do not care about the environment as much as they should. Have not had during the last two decades, special attention has been paid to the impact of sports organizations and their responsibility towards the environment at the policy-making levels of countries that seek to achieve sustainable development goals. Sports organizations, sports leagues, and other sports administrations at the international level, in addition to implementing venue management programs to maintain the health and safety of athletes and gain their material benefits, implement several programs in the field of environmental protection. The integrated combination of health, safety, and environment (HSE) is one of the homogeneous and effective structural factors and puts people in a measured relationship with others and the surrounding environment. The wise arrangement of these three issues has a constructive cultural and psychological reflection among the people of the society and provides a very suitable motivation for creating appropriate behavior and befitting a good life and promoting social interactions at a high level. The three issues of health, safety, and environment are one category that has mutual effects. The ultimate goal of each of these three issues is to preserve human health and life. Since humans are part of the environment, any factor that threatens human health is ultimately considered a threat to the environment. One of the necessities of combining these three issues is to prevent parallel work and reduce related costs. Today, many countries believe that paying more attention to the HSE category will lead to significant success in sports; because by using integrated HSE management, many problems and costs can be eliminated and a higher level of quality can be experienced in sports. Based on the sports experiences in developed countries, it should always be remembered that the implementation of HSE in a society is a sign of civilization and the level of culture of the people of the society. The results of the investigation on the HSE management system in sports venues are effective and necessary to create a safe and comfortable environment for spectators and help to create stability and peace in sports environments and the development of green sports throughout the country, and sports policymakers can operationally use the results. Take advantage of it and while strengthening the pillars of sustainable development, make a great contribution to strengthening the country's sports power.

The research method was exploratory, the statistical population of the qualitative part included academic elites and experts in the field of management, and the statistical population of the quantitative part included the activists and workers of sports clubs, including coaches, managers, and athletes. According to Cochran's sampling formula, 384 people were randomly selected from the available people. The data collection tool was a researcher-made questionnaire resulting from a semi-structured interview. According to the coding method of Strauss and Corbin, qualitative data analysis was done in line with the grand theory strategy in the form of 3 stages open coding, central coding, and selective coding. At first, with the help of the methodology of the theory derived from the data and the analysis of the texts resulting from in-depth interviews and the systematic review of the studies, the results of open, central, and selective coding are described, and then the paradigm model of the research phenomenon arising from the data method of the foundation, the models proposed by the researcher and also the antecedents. And the implications of the development of the HSE management model in sports clubs are presented as a result of the research results. All interviews are recorded and after conducting each interview, data analysis is done in order to base the model. The results of this stage are used to compile the final model with the structural equation modeling technique in SmartP software. L. S was done. This method is a complex mathematical and statistical combination of factor analysis, multivariate regression, and path analysis, and then the model was checked for quality, both the external model and the internal model were examined, and the reliability and validity indices of the external model were The standards were compared and at the end, the overall quality of the PLS model was evaluated.

The research findings showed that in 30 categories; 169 conceptual codes and 171 items in the six dimensions of the paradigm model in the form of causal conditions (5 categories, 36 concepts, and 37 items), the main and central phenomenon: HSE management in sports clubs (3 categories, 14 concepts, and 15 items), strategies ( 3 categories, 28 concepts, and 28 items), contextual conditions (7 categories, 41 concepts, and 41 items), intervening or mediating conditions (6 categories, 30 concepts, and 30 items) and consequences (6 categories, 20 concepts, and 20 items) and the fit of the research model (GOF = 0.686) was evaluated as appropriate.

In general, the results show that all human actions, including industrial, civil, and sports activities, should be at the service of man in order to improve the level of his material and spiritual life. In addition to its human and ethical framework, HSE can also be considered economically. Paying attention to HSE from the point of view of sports and in the field of sports competitions and having competitive advantages in sports means paying attention to all aspects of health, safety, and health of athletes and those who work in this environment to improve work processes in To increase performance. Therefore, it is suggested that more efforts should be made by more efficiently providing the tasks of the expert force in developing an integrated model (HSE) in sports venues.

In the last two decades, education experts have paid more attention to the categories of cognition and motivation. Cognition involves some mental abilities and actions such as knowledge, comprehension, recognition and thinking, and motivation is related to issues such as emotion, attitude and evaluation (1).
In this regard, motivation for academic achievement is one of the most important issues in the field of educational psychology and in this regard is considered as one of the most important predictors of academic performance. Research has shown the effect of cognitive processes and motivational variables as appropriate predictors of academic achievement as independent variables (1,2). One of the major variables that affect academic motivation is learning strategies. And one of the components of these learning strategies is the metacognitive strategy that is used in natural learning processes as self-regulatory learning (3). Another component that seems to be related to self-regulatory learning and academic achievement is self-efficacy. Which can affect almost everything, from mental states to behaviors and motivations (7).
In general, adolescence is a period of evolutionary cycle during which self-efficacy beliefs affect psychological outcomes. In this period, people face new challenges and how to cope and adapt to these challenges is partly influenced by the individual's self-efficacy beliefs (8).
Considering the above and the importance of self-efficacy and motivation in academic achievement on the one hand and the importance of controlling behaviors for academic achievement on the other hand, so unfortunately with the review of research conducted inside and outside the country, research on the subject was not found. For this reason, the researcher seeks to answer the question of whether the training of self-regulatory learning guides (cognitive and metacognitive) affects the components of self-efficacy, academic motivation and students' mental health or not?

The present study is experimental. To conduct this research, 46 first-year female students (second year) of Astara high schools who were studying in the 97-96 academic year were selected by multi-stage cluster sampling method and randomly selected. The two groups (23 experimental and 23 control) were divided. Then the questionnaires of motivational beliefs and self-regulatory learning strategies (MSLQ), academic motivation (AMS) and general health (GHQ 28) to collect data in the pre-test by Subjects completed. Subjects in the experimental group were trained in self-regulated learning strategies for two sessions per week for eight 90-minute sessions and the control group did not receive any training. Finally, descriptive statistics and Shapirovillek test, paired t-test and independent t-test using SPSS software were used to analyze the data.

The results showed that the mean scores of the experimental group in the post-test increased compared to the pre-test in the components of self-efficacy and academic motivation and decreased in the component of mental health (Table 1). On the other hand, it was found that there was a significant difference between the subjects in the experimental group who were trained in self-regulated learning strategies and the control group who did not receive any training in the variables of self-efficacy and academic motivation at the level of (p <5%). There is. But this difference is not seen in the mental health component. (Table 2).

The results indicate the effect of teaching cognitive and metacognitive learning strategies on the variables of self-efficacy and academic motivation, but this effect was not observed in the mental health variable. It is possible to create a greater sense of autonomy and self-efficacy by changing the conditions of teaching and learning so that students can play a more active role in their learning process. Therefore, it is suggested to consider self-regulatory strategies as part of educational interventions in order to make learners more efficient.
Another result of this study was increasing academic motivation in students who have benefited from the training of cognitive and metacognitive strategies. This result is also consistent with the findings of Poor Mohammad and Esmaeilpour (2015). They had high motivation and academic achievement (1).
Another result of the present study was that teaching learning strategies (cognitive and metacognitive) could not increase the mental health of students in the experimental group. This result is consistent with the findings of Tavakolizadeh (2011). He rejected the effect of teaching cognitive and metacognitive learning strategies on the mental health of second year middle school male students. The results showed that teaching learning strategies in the experimental group compared to the control group did not show a significant difference in terms of mental health status (19).

Depression is a feeling of extreme sadness and grief that can range from mild frustration to a feeling of great despair (1). Depression affects the quality of married life of individuals and impairs their performance more than anxiety disorders and as much as the most common medical diseases (2). In this regard, the development of intimacy between spouses is the first step towards creating a desirable marriage (5); Therefore, establishing and maintaining intimate relationships in marriage is a skill and an art that, in addition to early mental health and healthy experiences, requires the acquisition of skills and the performance of special tasks (6).
In this regard, research shows that the root of many marital problems is the lack of intimacy and communication problems between spouses (2). Dissatisfaction with intimacy may lead to increased conflicts, decreased marital satisfaction, and emotional and psychological problems (7); In today's society, couples have severe and pervasive problems to establish and maintain an intimate relationship, and often seek treatment to re-establish levels of trust and satisfaction in their relationship, especially issues related to emotional-communication ties with important people in life (9). People who have difficulty developing intimacy often seek counseling for their marital problem, while increasing and improving intimacy is often one of the goals of couple therapy (7). Therefore, various therapeutic interventions have been performed with people with low quality marital relationships, and it has been confirmed that one of the effective therapeutic interventions to improve the quality of marital relationships and promote marital intimacy is to enrich marital life training based on Glaser theory of reality therapy.
Considering the above and the importance of married life on the one hand, the negative impact of depression on life on the other hand and considering the impact of reality therapy on married life, therefore, by reviewing research conducted at home and abroad, research on the impact of reality therapy on Intimacy and marital satisfaction have not been performed in depressed married women. On the other hand, policymakers, researchers and psychotherapists in our country have not paid much attention to preventive methods and these methods need more scientific study, so the present study is necessary.

For the present quasi-experimental and applied research, which was conducted with the experimental and control group and the pre-test, post-test and two-month follow-up research plan, 30 depressed women referred to two counseling and psychology centers in Mashhad in 1398 (94 people) were 30 people. They were purposefully selected and randomly divided into two groups: reality therapy and control. After completing the consent form, they completed the Walker and Thompson Marriage Intimacy Questionnaire (1983) and the Enrich Marital Satisfaction Questionnaire (1989). Then, the subjects of the experimental group underwent 8 sessions of 90 minutes under the reality therapy program of Duba et al. (2009). Immediately after the intervention and two months later, the questionnaires were completed again by the subjects
Finally, descriptive statistics (mean and standard deviation) and Shapirovilk tests, analysis of variance with repeated measures and Bonferroni post hoc using SPSS software version 23 were used for statistical analysis of data.

The results showed that the mean marital intimacy of the experimental groups in the post-test stage increased compared to the pre-test. It was also found that group reality therapy intervention compared to the control group increased marital intimacy after the test and stability in the follow-up phase of married women. It was also found that the difference between the mean of marital intimacy between pre-test and post-test and follow-up stages was significant (P = 0.001) but the mean difference between post-test and follow-up was not significant, indicating that the results in follow-up did not return and the effect of intervention was stable. .
Another finding showed that the average marital satisfaction of married women in the experimental group increased in the post-test stage compared to the pre-test. It was also found that group reality therapy intervention compared to the control group increased marital satisfaction after the test and stability in the follow-up phase in married women. The results of post hoc test showed that the mean of marital satisfaction between pre-test and post-test and follow-up stages was significant (P = 0.001) but the mean difference between post-test and follow-up was not significant, indicating that the results in follow-up stage did not return and the effect of intervention was stable. have been.

The results showed that the mean of marital intimacy in the experimental group increased in the post-test stage compared to the pre-test. It was also found that training has been able to affect marital intimacy in the post-test and follow-up stages, and this effect has remained stable until two months after the end of training, according to the results of the Bephrone post hoc test.
In the above explanation, it can be said that in reality therapy, it emphasizes on cultivating a sense of responsibility to satisfy the basic needs of oneself and one's spouse and liberation from external control; Therefore, people may not have paid enough attention to their own needs and the needs of the other party, because meeting each other's needs in the marital relationship is one of the important factors in improving marital intimacy; However, attending reality therapy training sessions has been able to draw their attention to these important issues and to consider them in practice (2). Therefore, teaching how to look at these needs and meet them has been able to help couples. (20). As a result of reality therapy training, awareness about the intensity of couples' needs and creating a sense of responsibility has increased, and as a result, satisfying their needs has been able to play an important role in creating and improving sincere relationships.
Another finding showed that the mean of marital satisfaction in the experimental group increased in the post-test stage compared to the pre-test. It was also found that these trainings were able to affect marital satisfaction in the post-test and follow-up stages, and this effect remained stable until two months after the end of the training.
In explaining the results in terms of the effect of reality therapy, it can be said that Glasser's emphasis on accepting responsibility for each person's behavior helps people to examine and examine their own behavior instead of addressing their spouse's behavior and putting him or her under a magnifying glass. Play their part in problems and reduce marital satisfaction And thus improve their relationships; Reality therapy counselors based on Glasser's concepts try to increase couples 'trust, intimacy and marital satisfaction in their clinical interventions by increasing responsibility in couples and teaching communication skills, and strengthen couples' sense of commitment; Another factor that Glasser considers effective in strengthening and stabilizing marital relations is the couple's attention to each other's wants and needs; They learn to satisfy their own and their spouse's needs through loving behaviors (22).

In recent decades, due to variations in the lifestyle of human societies, the prevalence of autoimmune diseases and cancers have increased significantly. Imbalance in immune system responses is one of the key factors in this regard. There is a strong, dynamic, and mutual relationship between autoimmunity and cancer, although the underlying mechanisms of this relationship have not yet been elucidated. In some cases, therapeutic strategies used for the treatment of cancer and autoimmune diseases play a significant role in this relationship. Moreover, genetics, epigenetics, inflammatory and anti-inflammatory cytokines, lymphocyte plasticity, disease mechanism, and host symbiotic microbiota play an important role in this correlation.
A failure in tolerance, defects in apoptosis, the production of autoantibodies, autoreactive B and T lymphocytes, and ultimately the immune system's attack on self-tissues and cells can all lead to the development of autoimmune diseases. In addition, continuous exposure to inflammatory cytokines such as TNF-α and IL-1, external stimuli (such as low levels of lipopolysaccharide), and chronic infection leads to immune cell tolerance and dysfunction, which in turn results in autoimmune disease. In fact, autoimmunity is caused by an imbalance between regulatory T lymphocytes and helper T lymphocytes, an increase in the activity of the innate and adaptive immune systems, and the production of inflammatory cytokines. 
Recent studies indicate that systemic autoimmune diseases are associated with a higher occurrence of cancers and malignancies. Chronic and systemic inflammation of these autoimmunities is one of the key justifications for this hypothesis. Also, constant stimulation of the immune system makes it ineffective and anergic, which favors the development of cancer. These reports indicate that malignancies such as kidney cancer, lung cancer, thyroid cancer, melanoma, leukemia, hematologic malignancies, and lymphoma have a high incidence in patients with rheumatoid arthritis, as a systemic autoimmune disease. Surprisingly, some studies reported a reduced risk of cancers and malignancies such as colorectal, breast, cervical, and non-melanoma skin cancers in patients with rheumatoid arthritis. Patients with systemic lupus erythematosus, as a prototype of systemic autoimmune disease, have also been reported to be more susceptible to malignancies such as lymphoma, leukemia, central nervous system malignancy, kidney cancer, lung cancer, and hematologic malignancies. Interestingly, the risk of developing Prostate cancer, breast cancer, cervical cancer, and melanoma is reduced in these patients. Of course, it should be noted that in systemic autoimmunity, the increased risk of malignancy is more common. Also, it has been demonstrated that organ-specific autoimmune disorders are associated with a higher risk of cancers affecting that organ.
Today, cancer is a leading cause of death worldwide. Tumors can use the mechanisms of immune tolerance to overcome anti-tumor immune responses. In addition, tumors evade the antitumor immune response by downregulating the expression of tumor-associated antigens and major histocompatibility complex (MHC) molecules. Also, the tumor cells suppress antitumor responses by secreting soluble immunosuppressive factors such as interleukin-10 (IL-10), transforming growth factor beta (TGF-β), vascular endothelial growth factor (VEGF), adenosine, and prostaglandins, or involving immune checkpoints such as cytotoxic T-lymphocyte associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), T-cell immunoglobulin and mucin domain 3 (Tim-3), and lymphocyte activation gene 3 (LAG-3). In the tumor's microenvironment, immunosuppressive cells such as myeloid-derived suppressor cells (MDSC), regulatory T lymphocytes, tumor-associated macrophages (TAM), regulatory B lymphocytes, and regulatory dendritic cells may prevent antitumor responses.
As with autoimmunity, uncontrolled cytokine production or defects in cytokine signalling can contribute to cancer progression and recurrence. Today, chronic and uncontrolled inflammation is considered a carcinogenesis and progressive factor. With the development of cancers and malignancies, the immune system employs strategies similar to autoimmunity to limit the growth of cancerous tissue. As a result, in cancer therapy, attempts are made to induce similar strategies of autoimmunity against the tumor. Activating the immune system to fight cancer creates challenges that may predispose patients to autoimmunity.
Currently, research has revealed that various cancer treatment approaches, such as immune checkpoint inhibitors (ICIs), monoclonal antibodies, and adoptive immunotherapy, lead to immune-related adverse events (irAEs) such as autoimmune diseases. One of the main reasons for these adverse events is the induction of immune responses against tumor tissue following immunotherapy, which causes tissue damage, loss of self-tolerance, and autoimmunity induction. These adverse events can occur in the tumor target organ or in the other organs. PD-1 and CTLA-4 are two critical molecules that play a significant role in immune checkpoints, maintaining tolerance, and cancer therapy. In some patients, ICIs therapy causes immune-related adverse events such as chronic inflammation and autoimmune diseases which correlated with poor prognosis and reduced survival.
It seems that there is an important correlation between the processes associated with the development of autoimmunity and cancer. According to limited data in this field, it is essential to increase studies to identify biomarkers, polymorphisms, genetic and epigenetic predictors to assess this correlation and prevent the occurrence of autoimmune diseases and cancer simultaneously. In addition, immune-related adverse events can be predicted before drug administration to the patient by producing animal models and inducing both autoimmune disease and related malignancy.

Endometriosis is a common female disorder that affects 6 to 10% of women. Histologically, endometriosis is the excessive appearance of fibrotic tissue around the stroma and endometrial glands. Fibrosis in endometriosis is regulated by the Wnt signaling pathway, which plays critical roles in various diseases (1). B-catenin plays the main role of wnt intracellular transformation pathway in vertebrates. B-catenin is a multifunctional protein that functions both as a transcriptional and as a membrane and cytoskeleton interface protein (2). Several studies have shown that aberrant activation of wnt/b-catenin signaling may play a role in the pathology of endometriosis (3, 4). On the other hand, it has been shown that the lack of movement and vitamins lead to the creation of various factors in the development of diseases, and various factors such as immune system defects, genetics, hormones and environmental conditions have an effect on the improvement of the disease. In order to reduce the symptoms of the disease, increase the healing process and improve the quality of life of the patients, researchers emphasize the implementation of appropriate interventions (5). It has been shown that aerobic exercises are one of the training methods to improve the performance of infertility and women's diseases. Studies show that low-intensity aerobic training, by creating a protective mechanism, reduces the expression of inflammatory cytokines, oxidative stress in uterine tissue, systemic inflammation, and as a result improves immune responses (14). It has also been shown that vitamin E reduces the pain caused by endometriosis by inhibiting the release of arachidonic acid and also inhibiting the conversion of arachidonic acid to prostaglandin through the action on phospholipase A2 and cyclooxygenar enzymes (18, 19). The results of the investigation by Giampolino et al. (2019) indicate that there is a direct relationship between the group of vitamins and the recovery of endometriosis (20). In general, endometriosis is a multifactorial disease with a complex pathophysiology, and most of the details of this disease are still unknown; Therefore, the need for extensive research to obtain information for the pathophysiology of this disease is essential. Therefore, according to the studies conducted, no research was found on the role of physical activity and vitamin consumption, especially vitamin E, on the Wnt/β-catenin pathway of endometriosis rats, so in the present study, the researcher seeks to answer this question. Does a period of regular swimming exercises and vitamin E consumption have an effect on the changes of Wnt/β-catenin pathway genes in ovarian tissue of endometriosis model mice?

This study was of an experimental type, and 30 8-week-old female Wistar rats with an average weight of 202/85±15/62 grams were purchased from Pasteur Institute. In order to create an endometriosis model, first, adult rats were anesthetized using ketamine and xylazine. Then, using a scalpel, an incision was made in the skin of the flank area in the pelvic area. After opening the abdominal muscle and the peritoneal area, first, the ovarian tissue was removed along with a part of the fallopian tube tissue. Then it was placed in a sterile container with one cc of PBS (phosphate buffer solution). Then each tissue was cut into one piece by one millimeter. The tissue pieces, which were 4 pieces for each mouse, were transplanted to the right pelvic muscle wall area, to the abdominal peritoneum area, to the anterior abdominal wall muscle area, and to the fat around the ovary. Then, the surgical area was sutured and the mice were transferred to the corresponding cage (22). After the induction of the model, the mice were randomly divided into 6 healthy control groups, sham, endometriosis, endometriosis + vitamin E, endometriosis + swimming, endometriosis + swimming + vitamin E. The endometriosis group remained two weeks after the creation of the model until the end of the study, and the healthy control group was maintained for 8 weeks, and the endometriosis + vitamin E group started receiving the supplement on a daily basis and in the form of gavage two weeks after the creation of the model. The amount of 200 kg/mg body weight of rats was maintained for 8 weeks until the end of the study. The rats of the endometriosis + swimming groups swam 5 days a week until the end of the research period in a water tank with dimensions of 50 x 50 x 100 cm with a temperature of 30-32 degrees Celsius during 8 weeks. . The duration of training in water was 30 minutes daily until the end of the training period (23). In order to eliminate the acute effect of swimming training and vitamin E consumption, animal sampling was done 48 hours after the last swimming training program and vitamin E consumption. For this purpose, first the animals were anesthetized and then sacrificed, and after sacrifice, the transplanted tissues related to the endometrial area were evaluated for histology and genetic studies. Real time PCR technique was used to examine the expression of wnt and β-catenin genes in each group. After the laboratory analysis of the tissue samples, considering the normality of the distribution of the data from the parametric test including the one-way analysis of variance test and Tukey's post hoc test at the significance level of P≤0.05 to investigate the changes in wnt gene expression and β-catenin was used. All statistical operations were performed using SPSS23 software.

The mean and standard deviation of the research variables are presented in Table 2. Data analysis showed that there is a statistically significant difference between different research groups in the expression levels of Wnt and β-catenin genes (p═0.044, 0.048). The results of the follow-up test also showed that the expression levels of Wnt and β-catenin genes in the endometriosis group were significantly higher than in the healthy control group (p═0.035, 0.014). Swimming, vitamin E, and a combination of swimming + vitamin E were associated with a decrease in Wnt and β-catenin gene expression, and the endometriosis + swimming + vitamin E group had a significant decrease in β-catenin gene expression compared to endometriosis and endometriosis + vitamin E (p ═0.048, p ═0.05) and a non-significant decrease in Wnt gene expression (p═0.464, p═0.730).

The Wnt/β-catenin signaling pathway is an evolutionarily conserved cellular signaling cascade that plays a prominent role in various biological processes and the pathogenesis of many diseases, such as early embryonic development as well as organogenesis and adult tissue homeostasis. . Although the Wnt/β-catenin pathway exhibits many benefits, its dysregulation causes a wide range of diseases such as cancer, cardiovascular disease, and kidney disease (24, 25). Aberrant activation of Wnt/β-catenin has also been reported in patients with endometriosis or endometrial cancer. Abnormal Wnt/β-catenin signaling in the endometrium can lead to both embryo implantation failure and severe endometrial pathogenic changes such as endometrial cancer and endometriosis (26). Also, evidence shows that patients with endometriosis have higher levels of oxidative stress and inflammatory and pro-inflammatory cytokines (27). In order to reduce these symptoms, increase the healing process and the quality of life of patients, researchers have emphasized the implementation of appropriate interventions (28). Studies have shown that the consumption of food supplements and vitamins such as vitamin E, as well as exercising, controls the amount of estrogen in the body and helps to reduce the symptoms of endometriosis (29). In the current research, the effect of a swimming training program along with vitamin E consumption on the changes of Wnt/β-catenin pathway genes in endometriosis model mice was investigated. One of the important results of the current research is the abnormal increase in the levels of Wnt and β-catenin in the endometriosis model rats compared to the healthy group, which decreased with the intervention of exercise and vitamin E compared to the endometriosis group. In general, the results of the current research indicate that the regulation of Wnt and β-catenin gene expression in the normal state in the process of endometriosis can improve the level of this disease, and swimming exercises and the simultaneous consumption of vitamin E in the normal state of the Wnt /β-catenin pathway will be effective.

Athletes use variety of compounds to improve athletic performance and are constantly striving to improve capacity and performance. Various supplements are used by the masses and regularly by athletes in exercise to take advantage of the energizing properties as well as to prevent or delay fatigue (1). Dietary supplements, in addition to proper exercise and nutrition to improve athletic performance, are recognized, including caffeine and nitrate supplements. Since both beet juice and caffeine supplements are safe, effective, and legal, it seems that combining these two supplements and using them by athletes can have an increasing effect on improving athletic performance. Caffeine is used by many athletes as an ergogenic supplement, and low and moderate doses of caffeine (3 to 6 mg/kg) are very useful for a variety of exercise (2).
Also, the use of beet juice supplementation in speed runners increased the concentration of lactate in the blood, while there was no difference in the amount of oxygen consumed (7). According to the results of other studies, it seems that the use of nitrate supplementation can reduce the time required to run 10 km and maintain lactate levels in the constant range. However, it seems that 30 days of nitrate supplementation combined with continuous aerobic exercise can improve the performance of running 10 km compared to running alone, one of the mechanisms for which is stability at the surface Blood lactate (8). The results of a study showed that the use of nitric oxide as supplement can accelerate the clearance of lactate from the body after exercise and thus accelerate recovery (9).  In study of Bescós et al. (2011) two randomized blinds stated that the use of nitrate supplementation as a single dose of 10 mg per kg of body weight 3 hours before exercise had an effect on athletic performance and arrival time. Also, it did not cause fatigue and the use of this supplement and with this dose did not affect the heart rate (10). Belbis et al. (2018) examined the effect of 200 mg of caffeine on repetitive running activity on heart rate and lactate levels. The results of this study showed that caffeine supplementation at dose of 200 mg can increase performance in repetitive doses compared to counterparts in the control group (11).
Due to the very limited studies of supplementation of caffeine and beet juice and the lack of comparison of doses used in professional runners with field protocol and considering the conditions of intense aerobic and anaerobic training subsequently and in a short time in most sports to Improves anaerobic power and lactate threshold, as well as strengthens cardiovascular endurance during training and tournaments that probably have more than one training session per day, and considering that running is used as one of the pillars of training to increase the performance of athletes by coaches., Therefore, the aim of this study was to investigate the effect of short-term caffeine-beet juice supplementation on catecholamine changes, lactate and Rating of Perceived Exertion following intense anaerobic activity in elite male runners.

In this quasi-experimental study, 30 elite male runners (age 27.5±3.8 y, height: 176.7±7 cm, body fat: 9.9±1.7 %) were randomly divided into three exercise groups with 1) high dose supplement (9.6 mmol Beet extract and 400 mg caffeine), 2) low-dose supplement (4.8 mmol beet extract and 200 mg caffeine) and 3) placebo group (natural beet juice). total of 36 sessions were performed in three stages and two stages of six-day wash out between the first and second stages and the second and third stages. Levels of epinephrine and norepinephrine, lactate and pressure perception were measured. Data were analyzed using analysis of variance with repeated measures at the P<0.05.

The results showed that supplementation and exercise no significant changes in epinephrine levels (p = 0.93), norepinephrine (p = 0.89) and lactate (p = 0.37), but has had a significant effect on the perception of runner pressure (p<0.001). Also, supplementation and exercise caused significant changes in catecholamine levels (p<0.001). As the time elapsed after running, lactate levels decreased more than at baseline (p<0.001). Also, with increasing running distance, the rate of pressure perception increased (p<0.001).

The results of the present study showed that short-term supplementation with beet juice and caffeine was not able to significantly change the levels of catecholamines, lactate in elite runners, but was significantly reduce the pressure perception. The findings of this study were consistent with the results of Previous research (14-19). It has been shown that nitrate supplements for 15 days can reduce the perception of pressure, increase oxygen saturation and also increase the time to reach fatigue (23). Nitrate is an organic ion found in many foods, especially vegetables such as celery, beets, lettuce and spinach (24, 25). Following consumption, nitrate enters the bloodstream and has a shelf life of about 5 hours. Once absorbed into the bloodstream, nitrate is converted to nitrite and then nitric oxide, which can dilate blood vessels, increase blood flow, reduce muscle energy expenditure, improve nutrient delivery to muscle, and increase calcium ion release, and ultimately Improve runners' performance (26,27). Short-term nitrate supplementation appears to increase nitric oxide bioavailability and inhibit sympathetic vasoconstriction in resting or contracting muscle, however, some studies have shown conflicting results. Nitrate supplementation has been shown to be unable to alter vascular contraction due to sympathetic effects in young male athletes (27). also, the physiological effects of caffeine supplementation are not well understood, but it appears that the effects of caffeine on heart rate are influenced by the intensity of exercise and caffeine supplementation can reduce heart rate and blood pressure perception (32). It seems that the lack of significance in high and low doses of caffeine and beet juice supplementation on catecholamine variables indicates the lack of sympathetic effect of this combined supplement or that the presence of caffeine and nitrate together can neutralize each other. In relation to the exercise pressure perception index, the difference in the dose received by this combined supplement had a significant effect, which indicates that by increasing the amount, the pain perception threshold can be increased. Possible mechanisms include vasodilation, increased blood flow, improved delivery of nutrients and oxygen to the muscle, and increased calcium ion release and reduced fatigue. One of the limitations of this study is the lack of precise control of subjects in terms of food intake between the second to seventh day and also in the rest period between each stage. It also seems that individual differences in athletes' eating habits and body reactions may affect the response to variables due to the short duration of the intervention, especially in the case of caffeine, which despite the relative control during the study but the body Athletes show different responses to it, or the duration of the research is limited due to the professionalism of the athletes and the time that coaches allow them to participate in applied research. One of the strengths of this research is the use of supplements that are extracted from natural and daily foods. It is suggested that in future research on the recommended amounts of supplements with several different doses or in combination with other ergogenic supplements, preferably with a nutritional nature and not chemical and with a synergistic effect similar to this study and with longer use or in non-professionals. As well as other sports with the nature of endurance, strength or speed and skill to be considered. The results of this study showed that short-term supplementation with caffeine and beetroot juice as a source of nitrate did not cause significant changes in catecholamine, lactate and heart rate, but caused significant changes in runners' perception of pressure. Further studies are also needed to investigate possible mechanisms involved in athletes' anaerobic performance and more effective doses. It does not seem to combine these two supplements with each other or in higher doses compared to smaller amounts.

Asthma is a common chronic airway disease that has a dramatic effect on the process of life, group activity and socio-psychological functioning and even the economic progress of patients. There are currently 300 million asthma patients worldwide and it is predicted that by 2025, 100 million asthma patients will be added to the world population (1). Exacerbation of the symptoms of the disease affects the quality of life as well as the cost of treatment. Complications of chronic obstructive pulmonary disease include respiratory failure, pneumonia or other respiratory infections, right heart failure (pulmonary heart), arrhythmias, and depression. Asthma control is determined by the frequency of symptoms during the day, activity limitations, nocturnal symptoms, the need for essential medications, and lung function (4).
Studies show that unhealthy lifestyles such as inactivity and obesity are associated with negative health consequences in asthma patients, including poor asthma control (5). Among the measures taken to relieve symptoms and improve the functional status of patients with these diseases are pulmonary rehabilitation and breathing exercise and exercise programs that are part of it are used to improve functional status (6). Numerous clinical studies have shown that exercise, as part of a pulmonary rehabilitation program, improves asthma control and overall physical fitness in people with asthma and reduces hospitalization rates (7). Resistance training and strengthening the muscles of inhaling and exhaling are among the techniques that increase respiratory function in respiratory patients (8).
Regarding the beneficial effects of exercise in asthma patients, many studies have shown that physical activity and regular exercise play a beneficial role in reducing respiratory tract inflammation, shortness of breath and improving or maintaining pulmonary capacity such as Forced expiratory volume in the first second (FEV1) and has a Forced vital capacity (FVC) throughout the life of asthma patients (9-12). However, some studies have shown that during the period of sports interventions, patients had emergency conditions and exacerbation of asthma (13,14). Turner et al. Found that some patients had exacerbated asthma during exercise (14).
Asthma in adolescents and children can have detrimental effects on their mood and social activities. Over the past decades, a 100% increase in childhood obesity has been implicated in the prevalence of asthma because it affects the physiopathology and mechanics of the lungs. Because maintaining asthma control through medication is at a difficult level, it seems that getting help from lifestyle changes, such as including regular physical activity in the asthma patients' lifestyle, can help control asthma (8). Recent evidence in systematic studies has led to the support of aerobic exercise as an aid to the treatment of asthma, and despite standard treatment, its supply to asthma patients has become essential. However, the role of regular exercise, especially breathing exercises, in very limited asthma control has been investigated. Therefore, the present study investigated the effect of eight weeks of moderate intensity aerobic exercise on FVC and  FEV1 in mature and immature girls with asthma in humid environment.

In this semi- experimental trial, 60 girls students with asthma (30 mature and 30 immature girls; with average age of 8-18 years) from Rasht city were randomly selected and randomly divided into two groups include exercise and control. The aerobic exercise program was performed with intensity of  45-75% of maximum heart rate, 3 sessions per week for 8 weeks. Spirometry test was performed to determine pulmonary function before and after the training protocol. Data were analyzed using 2-factor analysis of covariance (ANCOVA) test at the p≤0.05. 

Aerobic exercise led to significant increase in FEV1 in girls with asthma (P= 0.000). There was no significant difference between the effect of aerobic exercise on FEV1 in mature and immature girls with asthma. Aerobic exercise led to significant increase in FVC in girls with asthma (P= 0.000). There was no significant difference between the mean FVC of mature and immature girls with asthma.

The results of the present study showed that after the intervention period, FEV1 levels  significantly increases in girls with asthma. Also, the mean FEV1 of adult girls was significantly higher than immature girls with asthma. The results showed that increasing FEV1 had beneficial effect on improving asthma control. The results of the present study are consistent with some previous findings (20-22). Increasing or improving pulmonary function with exercise seems to be related to reducing airway resistance, increasing airway diameter, as well as strengthening the respiratory muscles and the elastic properties of the lungs and chest. On the other hand, the effects of adrenaline and cortisol may be effective. Increased activity of the adrenaline system during exercise reduces the reversibility of the lungs and dilation of the pulmonary arteries. Also, the increase in plasma levels of cortisol as a bronchodilator is a very strong and strong production of surfactant in the lungs (19). Asthma is classified clinically according to the frequency of symptoms, expiratory volume with pressure per second (FEV1) and maximum expiratory flow rate (23). Strengthening the respiratory muscles, increasing the effective tail force due to strengthening the elasticity of the main and auxiliary intercostal muscle fibers, reducing obesity and thus reducing the pressure caused by the accumulation of fat around the chest have been reported as mechanisms of effect of exercise in improving lung function (25). In the present study, moderate-intensity aerobic exercise increased FVC in girls with asthma. The findings of our study also showed that aerobic exercise along with resistance exercise can be associated with an increase in  spirometry indices FEV1 and FVC. These results are consistent with the results of previous research (20-22). The value of the FVC index depends on the elasticity of the lungs, the authority of the airways. Studies have shown that the elasticity of the lungs, the position of the ducts between the alveolar region and the location of the stenosis and dilatation of the airway wall are effective physiological mechanisms in determining airflow at this stage. The increase in FVC appears to be due to aerobic exercise due to increased lung volume and elastic reversal of the lungs (11). There were some limitations in the present study; One of the limitations of the present study is the lack of measurement of lung function following ventilation. To determine whether the adjustments we observed are the result of exercise or increased ventilation, future studies should examine the effects of over-ventilation on changes in respiratory muscle strength and respiratory volume. Also, more research is needed to understand the effects of long-term aerobic exercise on respiratory volume. The results of this study showed that regular exercise with increased activity tolerance can facilitate the transfer of oxygen to body tissues. As a result, eight weeks of moderate aerobic exercise can cause a positive and favorable change in FEV1 and FVC indices in mature and immature girls with asthma.

Gastric cancer is the fifth most common cancer and the fourth leading cause of cancer death in the world. This genetically heterogeneous condition can be sporadic or inherited as an autosomal trait. One of the most important causes of sporadic gastric cancer is environmental factors such as Helicobacter pylori infection. In recent decades, proton-pump inhibitors (PPIs) have been widely used to treat gastrointestinal problems. New researches raise concerns about the link between PPIs and gastric cancer. The CpG island methylator phenotype (CIMP) seen in various malignancies is a set of epigenetic changes associated with promoter methylation and down regulation of the tumor suppressor genes. The present study investigated the methylation profile of MINT2, MINT1, MINT25 and MINT31 promoter regions in patients with gastric cancer. The MINT1 gene, also known as Amyloid-beta A4 precursor protein-binding family A member 1 (APBA1), is located on 9q and encodes a protein which is involved in signal transduction processes. Studies have shown a significant increase in MINT1 hypermethylation in gastric cancer tissues significantly associated with Helicobacter pylori infection. The MINT2 gene, or Amyloid-beta A4 precursor protein-binding, family A, member 2 (APBA2), has been mapped to the 15q region. Abnormal methylation of MINT2 has been identified in the blood and peritoneal fluid of patients with gastric cancer suggesting that it can be used as a predictor of peritoneal micrometastasis. The next two gene regions, MINT25 and MINT31, are functionally different. In fact, MINT25 is the Matrix metalloproteinase 24 (MMP24) gene, located at 20q. Studies have shown that MINT25 hypermethylation is a specific molecular marker for gastric cancer screening. The MINT31 marker is located at 17q in the non-coding region upstream of the CACNA1G gene, which is a T-Type Calcium Channel. MINT31 plays an important role in regulating CACNA1G expression. Studies have shown that hypermethylation of the MINT31 region can be used as a predictor of gastric cancer progression. Based on these findings, the present study investigates the methylation profile of MINT2, MINT1, MINT25 and MINT31 promoter regions in patients with gastric cancer. Another goal of this project was to investigate the correlation between this methylation profile and patients' clinical characteristics.

In this descriptive-analytical study, patients with adenocarcinoma gastric cancer between the ages of 50 and 85 years old were studied. The age matched control group included non-cancerous gastrointestinal patients who referred for endoscopy. Tumor and control tissue samples were collected by endoscopy. Collected tissue samples were extracted using the GENTBIO kit and DNA samples were kept at -20. Methylation-specific PCR (MSP) was used to determine the methylation pattern of selected gene regions. Bisulfite treatment was performed by Bisulfite Conversion Kit (ZYMO RESEARCH). Briefly, bisulfite solutions were prepared according to the kit instructions and were added to the samples. The mixtures were incubated for 5 hours then centrifugation was performed. In the next step a combination of BL buffer and carrier RNA were added to the products. The samples were then thoroughly mixed with ethanol and transferred to Epitect columns. BW wash buffer and BD desulfurizing buffer were used in later stages to improve DNA quality. For each reaction of PCR we used 2X PCR-master mix, 0.5µl of each forward and reverse primers with a concentration of 10μM and 50ng DNA. The following temperature program was applied: 15 minutes at 95°C, 35 cycles including 20 seconds at 95 °C, 30 seconds annealing with variable and specific temperature for each pair of primers, extension for 25 seconds at 72°C and final extension for 5 minutes at 72°C. The annealing temperature of the primer pairs was standardized between 51-60°C. PCR products were evaluated by 8% polyacrylamide gel stained with silver nitrate. After collecting and extracting the results, the data were analyzed using SPSS software version 19. P value less than 0.05 was considered significant.

Methylation profile of MINT2, MINT1, MINT25 and MINT31 promoter regions was assessed on polyacrylamide gel after treatment with bisulfite and MS-PCR. Each gene was amplified by a pair of primers for methylated (M) and a pair of primers for non-methylated (U) regions. In case of positive methylation of one or two genes, the situation was considered CIMP-Low phenotype and in case of positive methylation of 3 or 4 genes, phenotype was recorded as a CIMP-High. If the methylation of all four genes was negative, the CIMP-Negative phenotype was recorded. The results showed that CIMP was positive in 52.9% of gastric adenocarcinoma tissues, which included 41.2% CIMP-Low and 11.7% CIMP-High. MINT25 with 76% positive had the highest methylation rate. Interestingly, no positive cases of MINT25 were observed in the control group which could confirm the specificity of this marker. MINT31 was next with 53% positive cases. In control samples for three promoter regions, methylation results were negative and only two positive cases were observed regarding MINT31. MINT1 and MINT2 genes were evaluated positive in 17.7% and 11.8% of cases, respectively. According to these results, there was a statistically significant correlation between PPIs and methylation of MINT25 and MINT31 promoter regions. Considering all 4 gene regions as CIMP phenotype, the significance of the results was reduced, which could be due to the low sample size of positive cases in MINT1 and MINT2. Contrary to expectations, no significant link was observed between the Helicobacter pylori infection and methylation of each gene alone. However, the CIMP-Positive phenotype showed a stronger association with Helicobacter pylori infection than individual genes, although this association was not reached the significant level.

Gastric cancer is a multifactorial disease that despite the discovery of several predisposing genes, scientific evidence still indicates the important role of environmental factors in its development. Studies have shown the effective role of epigenetic changes in gastric carcinogenesis. Methylation of many genes has been studied in gastrointestinal cancers, including gastric cancer. Epigenetic instability, characterized by hypermethylation of multiple CpG islands, is known as the CIMP phenotype. CIMP-positive tumors indicate that hypermethylation has occurred simultaneously in the promoter regions of several tumor suppressor genes. This leads to inactivation of gene transcription and consequent loss of their function. So far, different gene sets have been selected to study CIMP in a variety of cancers, due to the heterogeneity of histological features in tumors and patient populations. In the present study, the promoter regions of MINT1, MINT2, MINT25 and MINT31 in patients with gastric cancer were examined and the results confirmed the presence of CIMP-Low and CIMP-High phenotypes in these samples. In our study, the correlation between methylation pattern and clinical characteristics of patients was also investigated. Statistical analyzes showed a significant link between methylation of MINT25 and MINT31 promoter regions with the PPIs. Evidence from several studies suggests that long-term use of PPIs is associated with a higher risk of gastric cancer. However, some studies have suggested that this risk may be limited to people with a history of Helicobacter pylori infection or precancerous lesions of the stomach. Because PPIs induce hypergastrinemia and cellular hyperplasia, they could increase the risk of gastric cancer. Overall, the results of our study show that the CIMP phenotype can be introduced as a biomarker in the diagnosis of gastric cancer, although the methylation profile selection should be standardized based on the characteristics of each population. The results of our study showed that among the 4 proposed gene regions, MINT25 has a statistically significant correlation with gastric cancer and also with a history of PPIs, which indicates the importance of studying this marker in Iranian patients with gastric cancer.

Transitional cell carcinoma (TCC) is a rare type of ovarian epithelial cancer. This type of ovarian cancer accounts for only 1% of superficial epithelial carcinomas. Ovarian cancer is a major clinical challenge in obstetrics and gynecology. The reason of this is the lack of specific symptoms for ovarian cancer before the recurrence and progression of the tumor, so many cases are not diagnosed until the onset of metastatic disease. Overall, ovarian cancer accounts for 4% of all diagnosed cancers and 5% of all mortality due to cancer. Malignant ovarian tumors are divided into several categories, including epithelial, germ cell tumors, and sex stromal cord tumors. Early diagnose of small ovarian-limited tumors is an important prognostic factor. Ovarian cancer has no specific symptoms and does not show itself in the early stages. The most common early manifestations are bloating, pain, frequent urination and constipation. Therefore, patients do not pay attention to the symptoms. The clinical manifestations of transitional cell carcinoma of the ovary are indistinguishable from other types of ovarian cancer. However, early detection of this type of tumor is important because of the favorable response to chemotherapy compared to other ovarian epithelial cancers.

Case report: 

The patient is a 43-year-old woman (G2P2L2) who referred to a hospital in Tehran with vaginal bleeding and abdominal pain. The results of sonography showed the presence of a suspected mass of uterine leiomyoma with dimensions of 90 * 58 mm and two cysts with a diameter of 43 and 39 mm in the right ovary. The patient is a candidate for myomectomy due to bleeding. In October 2019, during surgery, the surgeon discovered that the mass was not a leiomyoma and the mass was of ovarian origin.so she underwent curettage and the right ovarian mass were removed and sent for pathology, the diagnosis of “High grade serous carcinoma of the right ovary” is reported. Due to the malignancy, the pathology result, patient was referred to Firoozgar Medical Center in Tehran, In the review of the pathology report in this center by the gynecologist pathologist, primary ovarian transitional cell carcinoma was reported without need to do IHC (ImmunoHistoChemistry) because of the net diagnosis and the new ultrasound showed a hypoechoic, homogeneous, well defined and oval mass without clear vascularity with dimensions of 28 * 36 * 47 mm anterior to inferior vena cava (IVC) and proximal location of aortic artery bifurcation to common iliac and the effect of compression on IVC and Its displacement was seen. In spiral CT scan, a circular solid mass with dimensions of 42 * 33 * 51 mm corresponding to the location of the aortocaval with compressive effect on IVC and multiple mesenteric metastatic lymphadenopathy with a maximum SAD = 10 mm was seen. No free fluid was seen in the abdomen. The uterus had normal dimensions. Neurogenic masses such as paraganglioma and metastatic lymphadenopathy were presented in the differential diagnosis. Other normal abdominal areas were reported. Endoscopy and colonoscopy were also reported to be normal.
The patient did not have complete surgery, hence it was decided that in addition to the uterus and ovaries, the tumor between the duodenum and IVC would be removed in the reoperation. Therefore, on December 20, 2019, a complete laparotomy and debulking of the ovarian tumor, including a complete hysterectomy, removal of bilateral fallopian tubes and ovaries and remnants of the right ovarian tumor were performed. Appendectomy and omentectomy were performed also The tumor was removed on IVC. In the pathology report from the second surgery, primary  Transitional Cell carcinoma of the ovary with metastasis and involvement of right and left ovaries, parameter, lesion removed from the rectum, sigmoid mesentery, posterior cul-de-sac, seeding into the adipose tissue of the peritoneal lymph nodes of the right and left pelvis were reported.
One month after reoperation, the patient underwent 6 courses of chemotherapy every 3 weeks with paclitaxel 300 mg and carboplatin 480 mg with AUC-6 according to the advice given to the patient in the tumor board. Now that 2 years have passed since the patient's reoperation, the patient is in good general condition and no trace of the tumor or its recurrence, has been observed in regular follow-ups. In addition, the CA-125 patient before her reoperation is 450U / ml, and one month after surgery, who also received one course of chemotherapy, its rate decreased to 25U / ml, and after 6 courses of chemotherapy, its rate was 15U / ml. At present, the CA-125 level of patient is 10U / ml.

Transitional cell carcinoma is a rare type of ovarian epithelial cancer that is in the latest WHO classification, Introduced as” high grade serous tumor with transitional cell differentiation”. Primary ovarian TCC is differentiated from benign, metaplastic, or proliferative Brenner and has two subtypes; 1. Papillary 2. Malignant pseudo-Brenner. This tumor was first defined by Austin and Norris in 1987. They reported a group of patients with ovarian tumors that had tissue characteristics similar to malignant Brenner tumors, while these patients lacked benign Brenner tumor characteristics and no prominent stromal calcification. According to the World Health Organization (WHO), depending on the histological pattern, Transitional cell tumors are classified as benign, borderline or malignant tumors Brenner and TCC that accounts for 2% of all ovarian tumors.
Primary ovarian TCC is similar to bladder and urinary TCC but is differentiated in immunochemistry and pathology. Ovarian TCC is negative for CK20 but is usually positive for vimentin, ca125, wilms tumor1 and also strongly estrogen receptor (ER). Also, transitional carcinoma of the ovary is much more invasive than malignant Brenner tumor (MBT) and must be isolated. Silva et al observed TCC in 88 of 934 ovarian cancers (9%). Young et al in their study, stated that TCC tumor cell nuclei were longitudinal or round, often with nuclei with longitudinal grooves. The cytoplasm was often pale and granular, rarely clear or eosinophilic.
Common clinical signs of ovarian TCC include abdominal pain, ascites, bloating, and weight loss. Occasionally, there may be signs of uterine bleeding, back pain, urinary or abdominal symptoms. The clinical manifestations of this cancer are indistinguishable from other types of ovarian cancers. Our patient also referred to the hospital with symptoms of uterine bleeding and pain in the abdomen. Due to the absence of abdominal ascites and the generality of the symptoms, the tumor was not diagnosed in time. According to the sonography and symptoms, the first surgeon suspects leiomyoma and operates on the patient, but during the surgery, he notices that the mass is malignant.
In the study by Ihan et al, age of women with ovarian TCC ranged from 46 to 87 years, with an average age of approximately 59 years. Most patients had menopause. But in our study, the patient's age (43 years) is lower than the average age of previous studies.
Most studies show that surgery with chemotherapy (cisplatin) increases the life expectancy of patients. In the study of Silva et al, 5-year survival after surgery was reported to be 37% for 88 patients, while in the group with chemotherapy, it was 41%. The standard chemotherapy regimen recently used for patients with ovarian epithelial cancers includes paclitaxel and carboplatin on a six-period basis, our patient has also undergone chemotherapy with the same drugs.

A woman with a suspected ovarian mass should be examined and treated by a gynecologist oncologist. Histopathological examination of these tumors is necessary to distinguish them from other ovarian cancers. Immunohistochemistry features are useful in its diagnosis. Para-clinical methods can be used to evaluate metastasis. Surgery is the main method of treatment followed by standard chemotherapy.
This case is important because the patient had this tumor before menopause at the age of 43, who underwent surgery and chemotherapy with paclitaxel and carboplatin for 6 periods due to extensive metastasis to other abdominal organs. A noteworthy point in the above patient and similar patients is that, due to the non-specificity of ovarian cancer symptoms, whenever there is a suspected adnexal mass, referral to a gynecologist oncologist is recommended for beginning of appropriate treatment plan and surgery or chemotherapy to increase Survival and improvement of patient's quality of life.

The family is the first and most unique social institution and the health and well-being of a society is owed to the health and satisfaction of its members (1). The most prominent factor in the collapse of the family is the damage called divorce, which has devastating effects on the individual, the family and the community. Divorce may take place formally or legally or informally when the couple cohabites without intimacy and interest (2). Divorce is no longer an individual problem. Rather, it is a multi-stage process that is significant not only in terms of its effects on spouses and their children, but also because of its negative effects on society and the economy in general (7). In fact, emotional divorce is "the last step in a marriage." The rate of emotional divorces in the country is twice that of formal divorces. No action has been taken in relation to emotional divorce at home and abroad, and usually most actions are based on the emotional and emotional pressures of couples after divorce. The most important cause of divorce is the irresponsibility of the spouse (husband and wife) and the lack of adaptive skills. One of the barriers to marital problems and incompatibility, such as emotional divorce, is love addiction (10,11). Although, at present, love addiction has not yet found its place in psychiatry, there is now a greater understanding of behavioral addiction in the mental health literature (14). What is a missing link in the effects of emotional divorce can be a spouse with a high sensitivity to rejection that leads to marital bondage. Sensitivity to rejection is defined as anxious expectations of rejection, a state of defensive expectation. For quick understanding, it is a strong reaction to rejection that can be a potential barrier to conflicts in intimate marital relationships between spouses. Sensitivity to high rejection in one or both spouses can lead to personal discomfort as well as maladaptive behaviors that can damage the marital bond (15).
One of the most important ways to form a cohesive family is family education, and if the teachings are appropriate to the knowledge of individuals and attractive, it can provide the necessary information transfer (17). Imago is a couple therapy approach, developed by Hendrix to improve the quality of a couple's relationship (18). Schema therapy is also a relatively new treatment method for the treatment of chronic and persistent disorders (22). Schema examines how people think, how they perceive and process, and how they remember information. Inconsistent schemas lead to bias in the interpretation of events (23). Among the factors affecting the mental health of human beings, the family has a very important role, many mental and behavioral abnormalities of human beings are rooted in the family. Emotional divorce makes the couple sick and the children of the family suffer the most. Prolonged coldness of the relationship can cause depression and isolation of couples and mental disorders in them or lead to a series of infidelities that will cause serious harm to the family and society. Recognizing the symptoms and problems that lead to emotional divorce can be the first step to change. And identifying therapeutic interventions that improve couples' interpersonal relationships is clinically and theoretically important. The main purpose of this study was to evaluate the comparison of the effectiveness of schema therapy and imago therapy approaches on sensitivity to rejection and love addiction in emotional divorce.

The present study was a quasi-experimental study with a pretest, posttest and follow-up (quarterly) design with a control group. The statistical population of this study was the people who referred to Shahid Mofteh Judicial Complex in the west of Tehran in 2019. Purposeful sampling was used in this study. 137 clients who had referred to this branch to file a marriage complaint or request for divorce were selected according to the inclusion criteria and willingness to participate in the study. Then 101 people were initially evaluated according to Cochran's formula by the Emotional Divorce Questionnaire. After the number of clients reached the desired volume based on experimental theories, at least 15 people were considered for each group, and 45 people were randomly assigned to one of three groups: schema therapy, imago therapy, or control group. Interventions in two groups of schema therapy and imago therapy were held in parallel during 12 sessions of 90 minutes in groups and weekly. In order to analyze the hypotheses, multivariate analysis of covariance and Bonferroni post hoc test with repeated measures were used. In these analyzes, the effect of the control variable was removed from the dependent variable and then the groups were compared with each other.

The results showed that no significant difference was observed between the groups in the pretest. But in the post-test and follow-up, there was a significant difference between the mean of love addiction and rejection sensitivity in schema therapy and imago therapy with the mean of the control group at the level of p <0.01. Imago therapy approach was more effective in the love addiction variable than the rejection sensitivity variable in the schema therapy approach.

The results showed that schema therapy and imago therapy have a significant effect on sensitivity to rejection and love addiction compared to the control group in people involved in emotional divorce. Comparison of the two treatments showed that there was no significant difference between the mean of the rejection sensitivity variable by schema therapy and the mean of the imago group. It also showed that there is a difference between the effectiveness of schema therapy and imago therapy in reducing the variable of love addiction and this difference was in favor of the imago therapy group. The results in the follow-up phase are stable. We believe that the effectiveness of schema therapy is due to structural changes in the patient's personality, which is the goal of any schema therapist, and not only because of symptom improvements as a result of structural changes, but also due to initial emotional irregularity due to maladaptive regulatory strategy. Pathologies), gives way to emotional regulation (adults). Schema therapy and the need for new therapies, which can bring complete recovery to patients, will be a powerful boost to the study of new clinical applications of this model (34). Imago therapy training promotes dialogue between spouses, increases self-understanding and understanding of spouses, understanding of one's own childhood and spouse's childhood, as well as self-confidence (46).  According to research, love addiction seems to be abundant in people who have an insecure attachment style as a child and have a dependent personality and abandonment-instability schema. In fact, it is the prominent role of childhood that can have a significant impact on the creation of early maladaptive schemas as well as the creation of dependent characters and as a result addiction to love and emotional relationships in adulthood. Sensitivity to rejection often leads to distortions and misinterpretations of one's spouse's actions. Rejected children are also more likely to behave aggressively. People who experience high levels of rejection sensitivity experience greater levels of psychological anxiety if rejected. In fact, people addicted to love typically lose interest in activities outside of romantic relationships such as close friends, hobbies, and sports. And experience academic or work difficulties due to lack of focus on other areas of life (47). The present study, like other researches in the field of behavioral sciences, has faced limitations. Available sampling method Instead of non-random sampling, use self-reporting tool that can be considered as an internal interfering variable. schema therapy and imago therapy can be used to reduce the effect of rejection sensitivity and imago therapy can be used to reduce the variable of love addiction in people involved in emotional divorce.

Soccer is one of the most popular sports that is played by men and women, children and adults at different competitive levels. Metabolism and high energy demand in soccer training and matches, accumulation of lactic acid due to long-term play and short time between two halves of the match, do not allow the player to fully recover and rebuild his energy sources. This, in turn, can lead to the weakness of the body's immune system and, as a result, cause muscle fatigue. Some studies revealed that the pressure caused by playing soccer increases creatinine, urea and derivatives of white blood cells (leukocytes, monocytes and granulocytes), red blood cells and nitrates, and as a result, it causes disturbances in performance. The increase in urea production during sports activity indicates an increase in protein catabolism. An increase in serum values and a decrease in urinary values after sports activity indicate a decrease in kidney function in the elimination of waste products caused by heavy sports activity. According to the results of some studies, energy drinks consumption increases the metabolic rate, increases sports performance, or both. Hype energy drink (HED) is one of energy drinks that contains large amounts of taurine and caffeine. Taurine, which is the most abundant amino acid in type 2 muscle fibers, increases the strength of athletes and muscle hypertrophy and helps protein synthesis and muscle contraction ability. Also, caffeine has a lot of energy and many physiological effects, such as increase in plasma epinephrine concentration, release and reabsorption of calcium by the sarcoplasmic reticulum, as well as increase in muscle contraction. However, there is little information about the effects of energy drinks on markers of kidney damage caused by exercise. The results of limited studies showed that the consumption of energy drinks during exercise caused a significant change in the serum levels of urea and creatinine. White and red blood cells, hemoglobin and hematocrit did not increase compared to resting state, but the results of other research showed a significant increase in urea and creatinine levels. Considering the contradiction of previous research results and the lack of research on the effectiveness of energy drinks on kidney damage markers and hematological indicators in football, the main goal of the current research is to "investigate the effect of HED consumption on hematological and kidney damage indicators of soccer players after match.

Twenty-two male soccer players competing in Division 2 league with mean age of 91.36+1.20, weight of 70.50+8.01, and body mass index of 22.58+0.93 voluntarily participated in the study. All participants had at least 5 years of soccer experience and during the past year, they practiced 2 hours a day, at least 3 days a week. They were informed about the nature of experimental procedures, including potential risks and benefits and then, received written consent. The experimental protocols were approved by the Ethical Committee of Islamic Azad University of Rasht Branch, Iran, according to Helsinki Declaration Guidelines. All participants were subjected to two different conditions (HED and placebo consumption), under similar conditions (ambient temperature 20±1 °C and relative humidity 70±5). The two different conditions of the research were separated by 14 days to allow enough time for recovery between the tests and ensure the absence of caffeine's effect. In order to avoid diurnal effects, both experimental sessions were held in the early evening hours. Once, the participants consumed HED (2 servings of 250 ml per day) for 5 days before the soccer match, the day of the match and one day after the match. HED contains 99.1 kcal, carbohydrates, protein and fat, taurine, caffeine, glucuronolactone, vitamins, inositol, B6, B12, flavor and color. Participants were instructed to drink one serving with breakfast and one serving with dinner. Blood samples were collected before the race, immediately after the race, and 1 day after the race. All tests were performed at the same time of day to minimize the effect of circadian variation. In the second condition, a placebo drink was administered by an expert. Food industries without caffeine and taurine were prepared, which contained 50 mg/liter of sodium saccharin and 2.5 mg/liter of vitamin C powder supplement. It should be noted that both energy drinks and placebo were iso-calories. On test days, players were asked to eat lunch at 1:00 p.m., consume the cooled drinks in opaque and pressed plastic water bottles during (0.5 + 1 minute) under the supervision of the researchers at 4 p.m. At 5:00 p.m., the participants first warmed up for 15 minutes to increase the body temperature and improve the efficiency of the nervous and muscular system, then they were divided into two teams and played a soccer match in two halves. They played one minute with a 15-minute break between the two halves. During each trial, they were allowed to drink water to prevent dehydration. The measurements were done in 4 stages. Collected data using analysis of variance with repeated measurement of intersection at the level of significance of α=0.05 was analyzed.

The results showed that immediately after the football game, there was a significant difference in the levels of serum creatinine, hematocrit and white blood cells between the two conditions of HED and placebo (P = 0.001). Also, compared to placebo, consumption of HED 24 hours after the game caused a significant decrease in red and white blood cells, hemoglobin, hematocrit, urea and creatinine (p=0.001).

According to the results of the present study, it seems that the consumption of Hype energy drink causes a decrease in the levels of some enzymes of kidney function such as urea and creatinine and a decrease in the levels of some hematological parameters such as white and red blood cells, hematocrit and hemoglobin, and improves the performance of soccer players 24 hours after the match through accelerating the return to the initial state. Of course, due to the lack of scientific evidence in this field, it is not possible to make a definitive statement and the need to conduct more research in this field seems necessary.

Psychological pressures caused by modern life and rapid social changes that are formed under the influence of the rapid growth of industrial life have major effects on human mental health and can lead to disorders such as social anxiety (2). This disorder is defined as an obvious fear or anxiety about one or more social situations in which the person is exposed to attention and criticism by others. People with this disorder are extremely afraid of doing inappropriate behavior or showing signs of anxiety in social relationships and try to refuse to be in public places (3).
The issue of anxiety is so broad that it even involves the main organs of the body, for example, it is known that the brain is the central regulator of emotions, physical symptoms, thoughts and behaviors that explain many psychological problems. . Research studies showed that social anxiety disorder is related to dysfunction and brain waves (12). On the other hand, by examining the relationship between the underlying mechanisms of the thalamocortical brain and psychological states, it has been shown that by making optimal changes in the rhythm and frequency of brain waves, using neurotherapeutic methods, optimal changes can be made in a person's neuro-psychological states. (13). One of the methods of neurotherapy is neurofeedback. People can be aware of the cortical activities of the brain through neurofeedback. Basically, neurofeedback is a kind of biofeedback that tries to teach the patient some kind of self-regulation by recording the electrical waves of the brain and giving feedback to the person. So that in a conditioning process, a person learns to voluntarily change his brain waves using the feedback he receives from the device (14).
Now, considering the prevalence of social anxiety and considering the importance of the role of brain-nerve waves and psychological factors in the emergence and continuation of social anxiety and the fact that there was no research on the effectiveness of neurofeedback treatment as a neurotherapeutic method on social anxiety, and considering the importance Choosing the right treatment for these people, the researcher is trying to answer the question of whether neurofeedback treatment has an effect on the level of social anxiety and mental rumination of people suffering from social anxiety.

In order to conduct this semi-experimental and applied research, which was conducted in the field and with a pre-test-post-test-follow-up plan, among the people suffering from social anxiety referring to counseling centers under the supervision of the welfare organization in Shahin Shahr city in 1400 (150 people) ) a number of 30 people were selected as a sample in a targeted manner and diagnosed based on the cut-off point of Jarbak's social anxiety questionnaire (1996) and were divided into experimental (neurofeedback) and control groups (21). Next, the experimental group received neurofeedback treatment for 25 sessions (three sessions per week) under the supervision of the researcher. During neurofeedback, the subjects were seated on a comfortable chair in a quiet room, and electrodes were attached to the scalp using special glue according to the international 10-20 system (28) and the electrical changes from the brain surface were continuously recorded. was taking place The neurofeedback device is a tool equipped with a computer system that was used for neural feedback training. The data measurement tool included Jarbak's social anxiety questionnaire (1996) and Hoeksma and Maro's rumination response scale (1991). Finally, descriptive statistics (tables and graphs) and Shapiro-Wilk tests, analysis of variance with repeated measures, and Bonferroni's post hoc test were used to analyze the data using spss software version 24.

Due to the inequality of covariances, the modified Greenhouse-Geisser test was used to report the within-subject effects of social anxiety and its dimensions and mental rumination, and the results of the Wilks's lambda test for the effects of time and the time*group interaction were significant (<0.01). P). Also, the results for the average scores of social anxiety at the time of the results showed a significant difference (F=41.15 and P=0.001) between the different stages (time) of measurement (pre-test, post-test and follow-up) as well as the interaction of the measurement time with the group as (F=13.86 and P=0.001) is significant, in fact, the results show that the average scores of social anxiety and its dimensions in the test and control groups were significantly different from each other at different times of measurement (Table 1).
The results of the inter-subject effects also showed that the mean social anxiety scores of the experimental and control groups were significantly different from each other (F = 18.77 and P = 0.001). The obtained eta coefficient is equal to 0.472, which indicates that more than 47% of the changes in the average scores of the experimental group were related to the provision of neurofeedback treatment. Finally, the results of the Bonferroni test in the test and control groups in the 3 times of pre-test, post-test and follow-up in Table 3 show that there is a significant difference between the average social anxiety scores of the research groups in the post-test phase compared to the pre-test (P<0.01) and the follow-up phase. There was a significant difference to the pre-test (P<0.01), but no significant difference was observed in the average scores of social anxiety in the post-test stage compared to the follow-up stage (P<0.01).

The aim of the present study was to determine the effectiveness of neurofeedback treatment on social anxiety and mental rumination of people suffering from social anxiety in Shahinshahr. The findings showed that neurofeedback treatment was effective on social anxiety and mental rumination of people suffering from social anxiety. In explaining this finding, it can be said that neurofeedback has the ability to improve the activity of the middle and lower frontal areas and can regulate their activity. In addition, regulating the activity of the middle frontal gyrus reduces anxiety (34). In fact, anxiety is considered as an aspect of reducing self-regulation of the brain, and when the EEG is obtained from the patient, the state of anxiety is clearly evident; In addition, when the brain starts to self-regulate, its activities and functions improve (35). In fact, when the client is placed in the neurofeedback process, there is a good opportunity to learn to condition his brain wave pattern and increase the optimal level (32). Of course, the main reason for the effectiveness of neurofeedback can be attributed to the increased activity of the anterior cingulate cortex, which is responsible for modulating cognitive and emotional processes in the brain (33). With a quick look at the different dimensions of social anxiety, it is clear that these dimensions are somewhat consistent with what neurofeedback treatment is looking for. In fact, social anxiety includes the fear of speaking in public, which leads to a person's avoidance of starting or continuing conversations in groups, classes, public, or parties by reducing the effectiveness of verbal communication (36).

According to the report released by world health organization (WHO), the ST-segment elevation myocardial infarction- cardiogenic shock (STEMI-CS) is one of the important factors in patient mortality within hospitals (1), (2), (3), (4). CS and its related complications need a huge financial and medical burden. Some researchers stated that high mortality and complication rates of STEMI-CS patients are associated with the lack of effective early preventive treatments. Given the risk of CS and the different risk factors associated with it, accurate clinical risk prediction tools need to be developed to accurately predict the onset of CS. Recently, researchers have been used various machine learning methods to predict the risk of mortality in STEMI-CS patients. Recently, machine learning (ML) methods were developed to establish predictive models to identify the in-hospital mortality risk of STEMI-CS patients. The existing methods achieved encouraging results; however, their performance is not ideal, and more effort is needed to improve the performance. The aim of this study is to present a hybrid machine learning method for predicting the risk of mortality in STEMI-CS patients. Our proposed method combines a powerful swarm intelligence strategy, anti-coronavirus optimization algorithm (ACVO) with support vector machine (SVM) in risk prediction phase. The proposed model is compared with standard support vector machine (SVM), least absolute shrinkage and selection operator (LASSO), and adaptive neuro fuzzy inference system (ANFIS) on a real-world benchmark dataset.

To predict the mortality status of STEMI-CS patients, we proposed the ACVO-SVM algorithm. The proposed method is a hybrid machine learning algorithm that combines the SVM with ACVO algorithm to identify the most effective parameters on the death of patients. The incentive mechanism of using ACVO is to optimally configure the parameters of SVM to improve its prediction performance. The proposed ACO-SVM is also useful in determining the optimal subset of features and treatment strategies that have the greatest impact in predicting the status of STEMI-CS patients. The proposed approach models the problem of predicting the status of patients as an optimization problem. In order to determine the most effective features in predicting the survival or death of STEMI-CS patients, the proposed ACVO-SVM model is trained with different combinations of patient characteristics and adopted treatment strategies. Then the best combination of features that provides the highest performance is considered as the superior combination. To select the most effective features, first all the features are considered for training the SVM model, then the remaining features are ignored one by one and the model with the same structure is trained. The models were compared based on accuracy, recall rate, F1 criterion. Finally, the best model is used to predict the status of patients in test dataset. The data set used to evaluate the proposed method includes 410 records of patients hospitalized due to STEMI-CS complications in Shahid Madani Hospital of Tabriz University of Medical Sciences. The collected data is related to a 10-year period from 2009 to 2018. This data set includes five categories of main characteristics, which are demographic characteristics, type of myocardial infarction, risk factors, clinical symptoms, and type of treatment used. It should be noted that 80% of the records of the data set are considered as training data, and 20% of the records are considered as the test data set. The proposed method is implemented in MATLAB software.

Among M1 to M5 feature combination models, the experimental results show that the M1 model has higher performance on the training and test dataset in terms of predicting the patient's condition compared to other combination models. Model M1 includes the combination of characteristics of age, sex, type of myocardial infarction, smoking, percutaneous vascular interventions and coronary artery bypass surgery. This shows that considering the mentioned features has the greatest effect on the final condition of STEMI-CS patients. The results are in line with previous studies (2), (3) in this field, which stated that age, gender, smoking, coronary artery bypass surgery and percutaneous vascular interventions have the greatest effect on the mortality rate of patients. The M2 model ranks second in terms of efficiency in determining the status of patients, which shows that smoking also has a greater effect on the mortality of patients with STEMI-CS. Also, the M3 model indicates that the use of the balloon pump treatment strategy, along with other demographic symptoms of the patient, history of heart infarction and smoking have a great effect on the mortality rate of patients. In summary, it can be concluded that the demographic characteristics of the patient such as age and gender, smoking, history of illness and the use of coronary bypass surgery and percutaneous vascular interventions have a great impact on the mortality of STEMI-CS patients. The proposed ACVO-SVM approach is compared with several other popular approaches, which include: standard SVM model, LASSO regression, ANFIS, and XGBoost. The experimental results justify that the proposed ACVO-SVM outperformed its counterparts.

In this study, a hybrid supervised machine learning model was presented to determine the status of patients with cardiogenic shock due to ST-segment elevation myocardial infarction. The proposed ACVO-SVM model uses an ACVO optimization algorithm to estimate the optimal parameters of the SVM model, making the SVM training process more efficient. The proposed model was evaluated using a dataset of patients with cardiogenic shock and the results were compared with the LASSO, ANFIS, XGBoost, and SVM models. The results showed that the proposed method worked well compared to other proposed classification models. We also found that age, gender, type of myocardial infarction, smoking, percutaneous vascular surgery, and coronary bypass transplantation surgery are the most effective factors for survival in STEMI-CS patients. In this research, the models were evaluated on a small dataset. Therefore, one of the necessary tasks to improve this research is to evaluate the proposed method and other counterpart models on large datasets to determine their strengths and weaknesses. Another limitation of this research is the lack of examination of all factors affecting the survival of STEMI-CS patients, such as blood sugar level and duration of ischemia. For this reason, it is necessary to investigate all factors affecting the mortality of STEMI-CS patients to improve the quality of classification and prediction of the final status of patients.

 Workbooks are a key and important factor in learning. A portfolio is a purposeful collection of evidence that can demonstrate overall effort and progress in one or more areas. Portfolio-based learning should be used in all fields of medical education as an educational and evaluation solution. "Electronic portfolio is a tool for learning and measuring the learning process and product with the ability to store, organize, provide feedback, modify and review student's work in a digital environment based on the web, network or computer and can and can be like a showcase representing growth, progress, and skills. The student should be in the specific field" according to Barrett, one of the pioneers in the development of electronic portfolio in education, the electronic portfolio contains works that the learner collects, reflects, selects, and displays to show growth and change over time. The use of electronic portfolios in online courses as a good assessment tool is agreed upon by different researchers. According to some, portfolios provide an opportunity for self-evaluation, self-regulation learning, reflection, and the development of individual skills. In addition to being a good tool for assessment, the electronic portfolio can also be a good tool for learning. The portfolio is a collection of student evidence and documentation that shows their effort, progress, and academic success in a theoretical or clinical training course. The workbook provides useful information to the student that determines his success or weaknesses. In other words, a portfolio is a tool for empowering students, which, by adopting a collaborative approach, leads to independence in student learning and changes teacher-centered learning to student-centered learning. On the other hand, with performance-based training and creating learning conditions based on the needs of each individual, the work folder provides the possibility of fair education and judgment for educational environments. It fulfills tasks, presents documents and documents, introduces ongoing and completed tasks, selects and approves qualifications, encourages and promotes, and training and evaluates thinking skills and learning strategies. On the other hand, nowadays, considering the features of the information age and the rapid and continuous expansion of communication and information resources, it is inevitable to cultivate thinking in students to adopt the right measures and appropriate choices. A mindset is a tendency or tendency towards a specific pattern of mental behavior. Also, the nature of thinking is a stable tendency to discover, investigate, seek clarity, accept rational risks and think critically and with a lot of imagination. Considering the complexities of today's life and the many unforeseen issues that arise in various fields and the abundant need of people for lifelong learning and creating process skills in them, and also considering the complexity existing in medical fields that require the use of superior intellectual attitudes and the adoption of impromptu measures in emergencies, cultivating the intellectual attitudes of learners is one of the basic priorities that should be in the focus of curricula take Because thinking plays an important role in students' learning. Therefore, considering the importance of the role of the electronic workbook and the nature of students' thinking, it is necessary to identify the factors affecting it. Therefore, the main question of the current research is: What is the effect of the electronic folder on thinking habits and mental health in the University of Medical Sciences to present the model?

 This practical study was conducted with a mixed approach with a qualitative and quantitative approach with an exploratory design. Delphi method was used in the qualitative part and the descriptive survey method was used in the quantitative part. In the qualitative part, the statistical population included 18 professors of Shahid Beheshti University of Medical Sciences, among whom 13 were selected by targeted sampling based on the saturation law, and 1665 postgraduate students and assistants of Shahid Beheshti University of Medical Sciences were included in the study. became A small part of which 312 people were selected as a sample using stratified random sampling based on Cochran's formula. To collect data, a researcher-made electronic portfolio questionnaire with 47 questions and thinking tendencies with 50 questions were used. The face and content validity of the instruments was confirmed by the supervisor and the consultant, and composite reliability and Cronbach's alpha were calculated above 0.7. For data analysis, empirical factor analysis, confirmatory factor analysis, Friedman test, and structural equations were used using SPSS21 and PLS3.2 software.

 The results showed that the electronic portfolio has 6 dimensions, among which skill has the highest standard coefficient and attitude has the highest degree of correlation. Also, the results of the structural equation test showed that the effect of the electronic workbook on thinking patterns and mental health in graduate students and assistants of Shahid Beheshti University of Medical Sciences is significant.

 Therefore, it can be concluded that the electronic workbook affects the character of thinking and mental health of postgraduate students and assistants of Shahid Beheshti University of Medical Sciences. It is necessary to prepare and design the global citizen curriculum at educational levels, especially in higher education. Undoubtedly, one of the most fundamental tasks of education and training, especially higher education, is the training of informed, committed, active, creative, and comprehensive citizens. People who can adapt themselves to the values, customs, and traditions of the local, national and global society. The educational system, especially universities, compile and implement all learning activities and experiences in the form of a curriculum. The main elements of the curriculum, which include goals, content, teaching methods, and evaluation methods, and are specified according to the main components of global citizen education, including knowledge, attitude, and skills, provide a platform for learning and education. The results of the present research showed that the electronic work folder consists of 2 dimensions "evaluation and education" and 6 components "feedback, self-evaluation, fostering creativity, fostering critical thinking, learner progress, and metacognitive knowledge" and among these, the highest standard coefficient related to the dimension Skill is the lowest value related to the related knowledge dimension.

According to the World Health Organization, aging is a biological period with its own dynamic and out of human control, starting from the fertilization and ending with death (1). Balance control is the foundation of human ability to move and function independently (2). By increasing age, changes are made in the systems related to balance and movement. Structural and functional changes in the central nervous system have the most visible effect on motor performance (3) and the risk of falling increases in the elderly (4). Decreased mobility and balance along with the fear of falling can lead to decrease motor performance (6). The result of falling is injury, which can have physical and psychological consequences. It also causes costs for the individual, family and society (7). Therefore, according to the growing trend of the elderly population in the world, the need to pay attention to the importance of intervention strategies in the field of improving balance has been noticed by researchers. One of the individual or group-based intervention strategies is Fallproof program, which was proposed in response to the needs of  the elderly at risk of falling. This theory-oriented program with a multidimensional approach is effective in improving balance, mobility and reducing the risk of falling in the elderly (11). By proper design of exercice interventions, as well as repeatedly exposing the elderly to task demands and changing environmental conditions with the aim of reducing balance disorders, balance and mobility and falls can be affected to some extent. Fall prevention programs target the underlying injuries associated with postural instability through a comprehensive screening and evaluation protocol and its multidimensional planning approach (3). Considering Fallproof program is known as one of the effective programs in the field of rehabilitation of the elderly, and also by reviewing the previous studies, it was found that no study has been done regarding the optimal intensity of these exercises; Therefore, assuming the efficiency of Fallproof training on balance of the elderly, we investigated the effect of  high and low intensity Fallproof group-based training on balance of the elderly at different ages.

The current semi-experimental research with a pre-test and post-test design and its statistical population consisted of 55-77 years community-doweling in Tehran. After announcing the readiness of the volunteers, 60 people (26 men and 34 women) were clinically evaluated by a physician before any physical activity to confirm their physical and cardiovascular health. According to the research criteria, participants were divided into low intensity (20 people), high intensity (20 people) and control (20 people) groups by targeted sampling. Before evaluation, Fall Proof Health and Activity Questionnaire was used in order to obtain information about the general state of health, lifestyle and physical activity patterns. It was consisted of 22 questions, which provided three questions in the field of physical activity and exercise patterns in addition to knowledge of diseases, types of diagnosed injuries, and drugs used by participants. Fullerton's advanced balance (FAB) scale was used as a pre-test and post-test to evaluate the multiple dimensions of balance in functionally independent elderly and examines musculoskeletal, sensory, and neuromuscular systems, which may be involved in disorders. The test consists of 10 items which are: stand with feet together and eyes closed, reaching forward to object, turn in full circle, step up and over, tandem walk, stand on one leg, stand on foam with eyes closed, two-footed jump, walk with head turns, reactive postural control. Two experimental groups participated in Fallproof group-based program  three times a week for eight weeks (45 minutes per session), While the control group only participated in the pre-test and post-test. The exercises included center of gravity (COG) control, posture strategies, multi-sensory, strength and endurance, flexibility and gait pattern enhancement to improve the sensory, motor and skeletal-muscular system involved in maintaining balance (3). This research mainly focused on group-based training using entertaining games. The participants were asked to cooperate with each other to accomplish all of the tasks. As soon as the intervention was completed, the participants were evaluated again in the post test, using the (FAB) scale. Shapiro-Wilk test was used to evaluate the normal data and Lune's test was used to evaluate the equality of variance of the variables. Analysis of variance with repeated measurements (composite analysis of variance) and Bonferroni and Tukey post hoc tests were used at a significance level of 0.05 For data analysis.

The results of the Paired sample t test showed that Fallproof group-based training with low intensity improve the balance of the elderly 55-65 years. In addition, the results revealed that high-intensity Fallproof group-based training improve the balance of the elderly 55-65 years (P<00.5). The results showed that low-intensity Fallproof group-based training improve the balance of the elderly 66-77 years. The results revealed that high intensity Fallproof group-based training improve the balance of the elderly 66-77 years (P<00.5). There is a significant difference between the balance of 55-65 year in Fallproof group-based  with low and high intensity (P<00.5). The results showed that the balance of high-intensity Fallproof training  improved by 4.20 units compared to low-intensity. Also, there is a significant difference between the balance of 66-77 years in Fallproof group-based training with low and high intensity (P<00.5). The results showed that the balance of high-intensity Fallproof group-based training  improved by 4.40 units compared to low intensity.The findings of the composite variance analysis test revealed that there is a significant difference between the pre-test and post-test, and the exercises improved the balance of the elderly from the pre-test (24/33) to the post-test (28/65).The results indicated that there is a significant difference in balance between the age of 55-65 years and 66-77 years, and the balance of the age group of 55-65 years (28.033)  is significantly better compared to the age group of 66-77 years ( 24/95). The results showed that there is a significant difference in balance between the high training intensity and low training intensity groups and the balance of the elderly in the high intensity group (28.72) is significantly better compared to the low intensity group (26.37). In addition, the results showed that there is no significant difference in balance between the high and low training intensity groups in the pre-test. However, in the post-test there is a significant difference in balance between the high and low training intensity groups and the balance of the high intensity group (32.90) was significantly better compared to the low intensity group (28.60).

  According to the findings of this research, it can be concluded that eight weeks of high intensity Fallproof group-based training are more effective in improving balance in the elderly. According to the obtained evidence, older people were also able to use the benefits of participating in high intensity Fallproof group-based training. Therefore, it can be concluded that this program is probably an effective strategy to improve balance which will reduce the risk of falling to some extent in the elderly. Many specialists and those who work with the elderly can use Fallproof group-based training with high intensity along with other exercise protocols to improve balance and motor function.

Diabetic cardiomyopathy (DCM) is a functional, metabolic, and morphological deterioration of the myocardium caused by changes in glucose homeostasis caused by diabetes. miRs play a significant role in the occurrence of DCM. Reducing the overexpression of miR373 gene has a potential role in the appearance of this disease. Therefore, the purpose of this research was to compare the effect of six weeks of aerobic and resistance training on the expression of miR373 gene in mice with diabetic cardiomyopathy and male Wistar rats.

This research had a developmental goal, from the point of view of the experimental method and from the point of view of the laboratory execution method, with a post-test design. 36 healthy male Wistar rats with an average weight of 200 ± 20 grams and an age of 8 weeks were purchased from Pasteur Institute in Tehran. To induce diabetes, 50 mg/kg of streptozotocin (STZ) was injected intraperitoneally in a single dose to 27 rats. To confirm the validity of diabetes induction, glucose ≥ 200 mg/dl or hema index ≥ 3.5 were considered. According to research, diabetic cardiomyopathy occurs two months after the induction of diabetes. To confirm the occurrence of diabetic cardiomyopathy in the form of a pilot project, 3 heads of healthy rats (before the start of the research) and 3 heads of diabetic rats (after two months of becoming diabetic) were dissected and samples of myocardial tissue were taken. Rats with cardiomyopathy were randomly classified into four groups of 6 vertices (control, sham exercise, resistance exercise and aerobic exercise). A healthy group of 6 vertices was also considered for comparison with other groups. After two weeks of familiarization with the environment and learning to exercise, aerobic (running on a treadmill) and resistance (walking on an ascending ladder) training protocols were implemented for six weeks. 48 hours after the last training session (along with 12 hours of fasting), all rats were anesthetized using ketamine and xylazine and dissected and sampled from the left ventricular tissue. Real Time PCR was used to evaluate the expression of miR373 genes. For the statistical analysis of the data, ANOVA and T-correlated tests were used at the significance level of P ≤ 0.05.

Both exercise protocols led to a significant (P ≤ 0.05) decrease in fasting blood glucose (FBS) and insulin resistance index (HOMA-IR%). VO2peak (P: 0.1) of the aerobic group and 1RM (P: 0.73) of the resistance group increased significantly. The miR-373 gene expression level decreased in the control and sham diabetic groups compared to the healthy group, but increased in both exercise groups. But this increase was not significant (P > 0.05). It was also shown that resistance training had more significant changes on FBS and HOMA-IR indices compared to aerobic training (P = 0.001). Finally, aerobic and resistance training led to a significant increase in Vpeak (T = -4.9, P = 0.004) and 1RM (T = -7.68, P = 0.001).

Aerobic and resistance training improved the aerobic capacity and strength of the training groups, respectively. In addition, both exercises led to the improvement of diabetic complications (increased the expression level of miR-373), but aerobic exercise caused a better improvement of diabetic cardiomyopathy complications.

Multiple Sclerosis or MS is one of the most common chronic diseases of the central nervous system, which causes physical changes in the body and limits the performance of patients. Multiple sclerosis or M. S. is one of the most common degenerative diseases of the central nervous system, which leads to this disease being the most common cause of disability in adolescents. This disease leads to many mental disorders in people, among which anxiety thoughts and lack of hope for life and future are more than other negative consequences of this disease. Also, among the complications of this disease, it can be mentioned that the person's performance drops, which affects the way patients play their personal and social roles in their lives. On the other hand, research results show that patients with chronic debilitating diseases such as MS also face other specific problems related to their disease.
These problems increase secondary complications and limit independent life and have negative and destructive consequences on patients' lives. This disease and similar chronic debilitating diseases lead to a decrease in the quality of life of patients and create a background for their depression. Depression in these patients generally appears with aggression, irritability, anxiety, sociability, and specific reluctance. Depression is a motivating factor for the deterioration of the patients' disease, and the presence of depression in these people causes biological changes for the patients. Depression in these patients is accompanied by chronic fatigue, reduced quality of life and reduced results of drug treatments. Therefore, knowing the factors related to depression in these patients is one of the most important mental health factors and a productive factor in the disease process. On the other hand, research results show that the prevalence of MS in women is much higher than in men. Research results show that the prevalence of MS in women is 2 to 3 times higher than in men, and this rate is in the age range of 20 to 40 years. Life expectancy is one of the key indicators of human development, which is influenced by factors such as income, education, health and nutrition, and can help patients with chronic and debilitating diseases such as MS in better treatment of their disease. Therefore, the aim of this research is to investigate the effect of cognitive behavioral therapy in reducing anxiety thoughts and life expectancy of women with MS living in Tehran.

The current research can be classified from different dimensions. This research is a semi-experimental type with a pre-test-post-test design and follow-up with a control group and using the selection of test and control group subjects. The method of collecting information was library (using books, theses, publications, reliable internet sites, using information) and the method of collecting information was field and questionnaire. The statistical population of the current study includes all women with MS living in Tehran who are members of the MS Association of this city. The sample of the present study was based on the purposeful sampling method and included 30 people with this disease who were randomly divided into two experimental groups including 15 respondents and 15 controls. The collected data are related to the year 2019. The experimental group underwent cognitive-behavioral therapy for 8 1.5-hour sessions, which was not done for the control group. The current research tools include the hope scale of Schneider et al. (1991), which includes the THS Trait Hope Scale (1991), the CHS Children's Hope Scale (1993), the SHS State Hope Scale (1996), and the Wells Anxiety Thinking Scale (1994). Also, Wells' Anxious Thoughts Scale (1994) is a multidimensional tool for assessing worries. The content of this questionnaire was obtained from interviews with patients with generalized anxiety disorder and panic disorder. The analysis method in this research was based on multivariate and univariate covariance analysis as well as variance analysis with repeated measurements.

The results of the current research, which were obtained from different age groups; So that it includes 20% of the respondents in the age group of 20 to 30 years, 46.67% in the age group of 31 to 40 years, 20% in the age group of 41 to 50 years and 13.33% in the age group of 51 to 60 years. and also, 13.33% of subjects in the control group are in the age group of 20 to 30 years, 40% in the age group of 31 to 40 years, 20% in the age group of 41 to 50 years and 26.67% of the subjects in age group are 51 to 60 years old, it shows that the effect of cognitive behavioral therapy is effective in reducing anxiety thoughts and life expectancy in women with MS, a member of the Tehran MS Association, and cognitive behavioral therapy can reduce the negative and destructive consequences of MS. improve S in these patients. . heal and provide the basis for improving their quality of life. In other words, the application of cognitive-behavioral treatment methods based on cognitive strategies in challenging thoughts and inefficient cognitive and behavioral systems through skill training can be effective in improving the life expectancy of women with MS. Cognitive behavioral therapy with the mechanisms it brings is effective in reducing anxiety thoughts and increasing people's life expectancy. In fact, the key concept in the effectiveness of cognitive behavioral therapy and its more positive effectiveness than drug therapy is improving anxious thoughts and increasing life expectancy in accepting reality and responsibility for what has happened and the change that should occur. Although these people feel better by taking the drug due to the change in the chemical process related to brain neurotransmitters, they do not consider themselves responsible for this phenomenon. Also, tasks such as functional analysis, skill training and a feeling of mastery and empowerment are created in people, which are effective in increasing the motivation of treatment or at least continuity in treatment and avoiding irrelevant thoughts such as rumination. Therefore, it can be expected that cognitive-behavioral therapy has been able to increase the life expectancy of women with MS. The assumption of the normality of the distribution of the scores of the experimental and control groups in the variables of anxious thoughts, resilience and life expectancy according to the output results of the software, indicates the verifiability of the results. This means the normality of all data in the pre-test, post-test and follow-up comparison groups. Also, the non-significance of Levin's test in most cases, which is equal to (P<0.05), shows that the assumption of homogeneity of variances has been confirmed.

The richness of the present study is that patients with MS. They are prone to other diseases in the field of psychology, which we call multifaceted. Institutions related to the affairs of these patients should always consider the consequences of this disease. Therefore, the results of this research show that patients with MS are more likely to suffer from depression, and suffering from depression along with chronic motion sickness, including MS, can overshadow these patients even more. and this affects the quality of life of these patients. Therefore, focusing on resilience and creating sparks of hope and motivation in these patients can increase their vigor and vitality and facilitate the path of disease control.

The role of work in the dynamics of human life is undeniable and can be considered the center of human and social communication. To this end, women, as half of the population, undoubtedly have a direct impact on the sustainable development of society. Women have long been responsible for life and work alongside men, because the goal of any society Maximizing social welfare. To date, research on the impact of non-work domains on job outcomes has focused primarily on family-work interaction. Work-family conflict is considered as one of the most important issues in the world of work. The relationship between family characteristics and what happens in the workplace is quite understandable, but the role of leisure and recreation in work-related issues is less considered. In the functionalist view, leisure has functioned at the micro and macro levels. The choice of individuals to spend leisure time is one of the freest choices, but it is influenced by the social, economic, and cultural conditions of society, as well as by the psychological characteristics of the individual. Paying attention to leisure time has also been considered in the field of positive psychology, and in particular, selective leisure activities and is based on the personality abilities of individuals are important. The positive impact of competencies in life and leisure support mental health, which includes not only mental illness, but also the optimal functioning and prosperity of human beings. In fact, leisure enrichment based on the empowerment-oriented approach has been widely considered. Competency-based leisure is basically the way in which individuals select activities based on the therapist's abilities recognized and evaluated by the therapist and incorporate them into their daily routine. Another positive psychological construct that can affect the management of work-family conflict is resilience. Resilience is not just passive resistance to injury or threatening conditions, but the resilient person is an active participant and builder of his environment. Resilience is a person's ability to strike a biological-psychological-spiritual balance in the face of risky situations: a kind of self-healing that has positive emotional, emotional, and cognitive consequences. According to Bandura, resilient individuals behave through four processes: cognitive, emotional, motivational, and selective. Does the present study examine whether investing in leisure based on personality traits can reduce work-family conflict, and is this possible through resilience? Also, the question arises as to which of the leisure personality traits is most effective in reducing work-related conflicts?

The method of this research is descriptive-correlational research based on the structural equation modeling method. The statistical population of this study was all women working in hospitals in District 2 of Tehran. The sample size is equal to 200 nurses in this area. Cluster random sampling method was used to select the sample. First, three hospitals were randomly selected from all hospitals in Region 2 and the required number was randomly selected based on the required sample size. The research collection tool includes the following: Work-Family Conflict Questionnaire: An eighteen-item multidimensional questionnaire for measuring work-family conflict was used by Carlson et al. (2000) to assess the severity of the work-family conflict. This scale assesses the six dimensions of work-family conflict. The range of answers from option one (strongly disagree) to five (strongly agree) is arranged using the Likert scale. Empowerment-oriented leisure questionnaire to measure empowerment-oriented leisure, a researcher-made questionnaire was used. This questionnaire is designed based on the 24-item questionnaire of Secretary Patterson and Seligman (2004) and according to the theoretical foundations of leisure and secretary competencies. Connor & Davidson Resilience Questionnaire: This questionnaire was prepared by Connor and Davidson (2003) by reviewing the research resources of 1991-1999 in the field of resilience. The questionnaire consists of 25 items that are scored on a 5-point scale between zero (completely incorrect) to five (always correct). The data of this study were analyzed using path analysis modeling using LISREL software.

The collected data showed that leisure based on wisdom and excellence increases resilience and by increasing it can reduce work-family conflict. Competencies based on wisdom and excellence have not been able to have a direct effect on work-family conflict, but rather this effect is indirectly due to resilience. At the same time, leisure-based on humanity, courage, and spiritual capital has no significant effect on work-family resilience and conflict.

This study aimed to design a relationship model between empowerment-oriented leisure and work-family conflict mediated by resilience. The statistical population included nurses of Tehran Region 2 hospitals. The collected data showed that leisure based on wisdom and excellence increases resilience and by increasing it can reduce work-family conflict. Competencies based on wisdom and excellence have not been able to have a direct effect on work-family conflict, but rather this effect is indirectly due to resilience. Today, recreational therapy, as one of the methods used to target recreational programs, seeks to increase the quality of performance in leisure and, consequently, increase the quality of life. Also, in recent studies in the field of leisure and also in the field of psychology, this variable has been considered as a variable affecting other activities and areas of life. The results of many studies confirm the effect of personal life components on work life. Leisure, as one of the important aspects of personal life, can affect people's working conditions by influencing life satisfaction and physical and mental health. Leisure time can act as a source of renewal, and choosing targeted activities for it can affect other aspects of a person's life. In addition, leisure time should play an effective role in satisfying the latent psychological needs of human beings and is one of the effective areas in increasing the power of adaptation and resilient behaviors. Therefore, leisure activities can promote resilient behaviors in any aspect of life. With the increase in positive emotions that a person experiences to make a satisfactory choice of leisure time, the ratio of positivity increases, and although the source of stress may not be eliminated or even reduced in some way, nevertheless job stress. And work-family conflicts are reduced and the individual will enjoy higher emotional and psychological well-being. Many studies now conceptualize leisure satisfaction as a specific indicator of mental well-being that can be explored by focusing on leisure assessments and emotional responses to leisure. As the research findings show, leisure-based on micro-ability and excellence with a positive effect on resilience, have been able to reduce the level of work-family conflict. Personality abilities affect the way a person thinks and choices from any situation. In general, the virtues of wisdom and transcendence have a significant relationship with the orientation of a pleasant life. Wisdom is a kind of intellectual ability with features related to creative and critical thinking that includes the acquisition and application of knowledge, and naturally, any kind of knowledge acquisition can help to achieve a good life. Transcendence facilitates one's connection with the infinite world and thus gives meaning to one's life. Another part of the results of this study shows that resilience has been able to reduce the level of work-family conflict. Resilience is more important in jobs that face unpredictable situations and empowers the individual to meet unexpected expectations. Finally, it is suggested that due to the importance of leisure time on job characteristics, organizations to take advantage of this area to promote the occupational health of their employees, and help their employees to adapt their leisure activities to their personality to be more exploited. Have positive consequences.

Adolescence is one of the most sensitive periods of a person's life, one of the most important tasks of psychologists and counselors is to pay attention to the problems and problems of teenagers. Part of teenagers' tensions and problems are caused by the transformation of normal growth; such as growth and hormonal change, and another part is caused by the changes that occur in connection with the change of role in the society, that if the teenager does not have the necessary skills to deal with individual and interpersonal issues, adverse consequences will occur. In fact, most teenagers are faced with low self-esteem and negative self-concept, confusion, increasing negative emotions such as anxiety and depression, and as a result, reducing adaptive and positive functions. One of the problems that teenagers face during their lifetime is the fear of negative evaluation. Some people make a negative and unique evaluation of the event, which causes a constant fear and dysfunction in them, which can be internal (like I am incapable) or external (like, no It is not a safe place. Such evaluations create powerful emotions such as anxiety, anger, regret or guilt and symptoms of arousal, and these symptoms motivate the person to control the symptoms by adopting some methods. In turn, it causes the intensification of malfunctions. One of the sources of severe and continuous fear of a person is the evaluations he makes of the event or its results, negative evaluation of the event including negative evaluation of the emotions that occurred during the event and inappropriate event and negative evaluation of the feeling. The actions and activities that occurred during the incident and the inappropriate event and the negative perception of the responses of others and the perception of sustainable change in life after the event. One of the sources of persistent and intense fear may be a type of cognitive processing style during the event, which is called psychological failure. In order to deal with the fear of negative evaluation, psychotherapists investigated and pursued different treatment methods. Among the psychotherapy methods, we can mention therapy based on acceptance and commitment, as well as reality therapy. Reality therapy is a type of therapy that can be used for all people who have problems. Not denying the reality, taking responsibility and, accordingly, planning to achieve the goals, is one of the most important human needs in the life process, which is given importance in this therapeutic approach. Reality therapy is based on the choice theory. Reality-therapy considers behavior to include four components of performance, thinking, feeling and physiology, which we have direct control over two components of performance and thinking and indirectly over feeling and physiology. This treatment method emphasizes facing reality, accepting responsibility, recognizing basic needs, making moral judgments about the rightness or wrongness of behavior, focusing on the here and now, internal control and, as a result, achieving identity. Considering that the researchers are of the opinion that for fertility and progress, the society should nurture people with high mental health and considering that so far there has been no research to investigate and compare the effectiveness of therapy based on acceptance and commitment and reality therapy on fear of evaluation. The negativity of the students has not been addressed, and considering the importance of treating the students' malfunctions, as well as with the aim of preventing damage and improving the level of mental health, the necessity of conducting this research is revealed. Therefore, the current research aims to answer this basic question: Is there a difference between the effectiveness of acceptance and commitment-based therapy and reality therapy on the fear of negative evaluation of female secondary school students?

The research method was a semi-experimental pre-test-post-test design with a control group. The research community consisted of all female students of the second year of high school in Fasa city in the academic year of 2021-2022. From this, 45 people were selected among the eligible people and randomly assigned to two experimental groups and one control group (15 people in each group). For the first group, an intervention based on acceptance and commitment was applied, and for the second group, reality therapy was applied, and the control group did not receive any type of therapy. Research data with the help of the short version of Lori's fear of negative evaluation scale (1983), collection; and it was analyzed using analysis of covariance and Tukey's follow-up test.

The findings of the covariance analysis showed that the therapy based on acceptance and commitment and reality therapy significantly improved the fear of negative evaluation in the post-test stages (p<0.01); However, no significant difference was observed in the post-test between the two experimental groups.

According to the findings, it can be concluded that these treatments play a significant role in improving students' fear of negative evaluation, therefore, by identifying and introducing students to treatment centers and receiving psychotherapy protocols. Their mental health can be improved. Also, in explaining the effect of reality therapy on the fear of negative evaluation by the evaluator, it can be said that people with high scores in fear of negative evaluation are easily disturbed by their emotions in stressful situations and have high levels of chronic anxiety in different periods of family life. And conversely, people with a low fear of negative evaluation, because they have a clear definition of themselves and their opinions, can choose their own direction in life and in extreme emotional situations that lead to involuntary behavior and decision making in many people. Fails don't lose control and make decisions based on reason and logic. For this reason, these people will be less in critical situations with appropriate decision-making, because they will solve problems at the right time and in a more appropriate way, and they will face fewer unsolved problems. Behaviors, qualitative world and lack of external control can help to increase management and reduce the fear of negative evaluation in relationships, especially academic relationships. As a result, it can be said that reality therapy based on the theory of choice helps to choose responsibility and self-control and freedom. It also teaches people that they have acquired a successful identity and can make better choices based on reason and logic and away from emotion in their decisions and without believing in controlling behavior. And felt by others, and in this case, they become more positive people, and with choices without mixing with others, they experience a quality life, more successful communication, and more compatibility, and have less fear of negative evaluation.

Amyotrophic Lateral Sclerosis (ALS) is the most common fatal motor neuron disease characterized by involvement of the combination of upper (UMNs) and lower (LMNs) motor neurons. The degeneration of LMNs and UMNs leads rapidly to progressive muscle atrophy and paralysis, dysphagia, dysarthria, fasciculations, muscle cramps, and finally death due to respiratory failure.
ALS is an adult-onset neurodegenerative disease; its age at onset (AAO) is usually 50-60 years. However, AAO of the disease is variable (1 - 94 years old). Mean survival of patients with ALS has been reported as 3-5 years from the disease onset. However, 10-20% of patients survive more than 10 years. The incidence and prevalence of ALS in the European population is 1–2 and 2-7 people per 100,000, respectively.
Due to the great clinical variability in ALS manifestations, the diagnosis of ALS can be challenging. Thus, the El Escorial criteria were developed based on clinical data to ALS diagnosis.
ALS can be categorized into different forms:

It can be classified into familial and sporadic based on the presence and absence of other patients in the family. Most ALS cases are sporadic (SALS) and only about 1-13% of ALS cases are familial (FALS).
It can be sub-grouped based on the mode of inheritance of the disease; autosomal dominant, autosomal recessive, X-linked, mitochondrial or de novo.
ALS can be categorized based on the age at onset of the disease: juvenile ALS; age at onset below 25 years, and adult ALS; the onset age is over 25 years old - usually the onset age of the disease is over 45 years old.
ALS can be classified based on the locus and gene involved in the development of the disease. To date, more than 40 ALS-causative genes have been identified. These loci are only responsible for about two-thirds of FALS and about 10% of SALS.


Molecular analyses of the known ALS genes have demonstrated that their encoded proteins are involved in several physiological pathways, including, oxidative stress, axonal transport, autophagy, proteins folding, glutamate excitotoxicity, RNA metabolism and involvement of non-neuronal cells (microglia, astrocytes and oligodendrocytes).
Among the ALS-causative known genes, five genes including SOD1, C9orf72, TARDBP, FUS/TLS and TBK1 seem to more important and account for about 15% of all ALS patients. Meanwhile, mutations of SOD1 and C9orf72 genes are detected in a significant percent of patients.
Superoxide dismutase 1 gene - SOD1 - is the first gene identified for ALS disease. Mutations of this gene have been observed in 20% (12-23%) of FALS cases and about 3% (1-7%) of SALS patients.
The repetitive sequence of six nucleotides (GGGGCC; G4C2)n in intron 1 of the C9orf72 gene was also associated with ALS. The number of G4C2 repeats in healthy people is less than 23, while in affected individuals, the number of these repetitions was more than 23 and up to 1500 and even more. The dynamics of such repetitions in this gene may be an explanation for the phenotypic variability and different penetrance of the disease in these families.
The cause of most ALS cases is not yet known, but it is certain that several cellular functions are disturbed in the motor neurons of these patients, which can probably lead to the degeneration of these neurons. It is clear that most of the genes responsible for ALS do not exclusively play a role in the development of this disease, and mutations in these genes are not only involved in the development of ALS, but also can result in the occurrence of other neurodegenerative disorders like frontotemporal dementia (FTD), hereditary spastic paraplegia (HSP), Parkinson disease, progressive supranuclear palsy, ataxia, corticobasal syndrome, and Huntington disease-like syndrome. So, understanding the pathogenesis of ALS is essential in developing diagnostic methods and providing new effective treatments in the clinical trials.
Here, we reviewed the clinical, epidemiologic and genetic of ALS and briefly explained those in Iran. Our results showed (a) the average incidence and prevalence of ALS were 0.42/100 000, and 1.57/100 000, respectively. (b) In contrast to European countries, mutations of SOD1 are the common cause of ALS in Iranian FALS patients; they are causative in approximately 30% of the FALS cases but mutations of C9orf72 are rare. (c) A significant difference in disease progression rate is observed between patients who used riluzole and those who did not.

After heart disease, cancer ranks as the second biggest reason for death worldwide. The most common cancer treatments include chemotherapy, radiation, surgery, and hormone therapy. Combining treatments, depending on the stage of the cancer, can increase its efficacy. However, chemotherapy medications also have an impact on the healthy cells that surround cancer cells. Also during bone marrow suppression, immune cells, such as lymphocytes and leukocytes, which are needed to protect against tumor cells, are attacked. The condition can be made worse by a reduction in immune cells or activity. Utilization of immunomodulatory agents to enhance immune replication may be an alternative treatment for cancer. These therapies, along with other immunomodulatory agents, refer to "adjuvant therapy". Immunomodulatory substances, such as probiotics, aid in the fight against cancer by increasing cancer cell death and protecting against oxidative stress (1). Therefore, nowadays, the wide acceptance of natural therapies such as the use of probiotic supplements with therapeutic application has improved the quality of life of people. Probiotic supplements, that mainly include live microorganisms of the Bifidobacterium and Lactobacillus species, have been studied for a range of health advantages in recent years (2). The potential of probiotics to eliminate carcinogens has been linked to a number of various processes (3). Most probiotics are members of a sizable group of the most dominant bacteria in the gut microbiota. A few of these microbes are Lactobacillus bacterial strains, which have a low risk of causing disease in people and animals and have a long history of being utilised in food production without causing any negative consequences (4, 5). Apoptosis is the process of programmed cell death that can play an important role in the prevention and treatment of cancer (20, 21).The mechanism of probiotic-induced apoptosis, its impact on the immune system and the possible benefits of apoptosis induction during probiotic therapy are discussed. Also Probiotics have been found to cause physicochemical changes in the colon that contribute to the breakdown of carcinogens. Furthermore, research has shown that probiotics decrease microorganisms related to colorectal cancer, such as Fusobacterium (89). According to all known research, probiotics stimulate apoptosis in cancerous or altered cells but do not always induce cell death in normal cells (15). In this regard, a study showed that treatment with oligofructose maltodextrin-enriched Lactobacillus acidophilus, Bifidobacteria bifidum, and Bifidobacteria infantum controlled the gut microbiome and increased TLR2 expression while decreasing TLR4, caspase 3, COX-2, and β-catenin (22). Exopolysaccharides (EPS) from nine Lactobacillus strains promoted apoptosis and G0/G1 cell cycle arrest in the colon cancer (23). Lactobacillus and Bifidobacterium activate pro-caspases and pro-apoptotic Bax while inactivating anti-apoptotic Bcl-2 proteins, causing cancerous cells to apoptosis (24). Moreover, the gut microbiota plays a critical role in chemotherapy medication metabolism, reduces chemotherapy side effects, and modulates the anti-cancer activity of these treatments (90). Chemotherapy-induced diarrhea, gastrointestinal side symptoms were reduced in acute leukemia patients who took L. rhamnosus (45). Furthermore, research has revealed that L. rhamnosus reduces the detrimental effects of chemotherapy by modulating the immune system (46). Through increased expression pro-apoptotic BAX and suppressor anti-apoptotic BCL-2 proteins, prophylaxis administration of L. rhamnosus GG and L. acidophilus in conjunction with celecoxib diminished tumor size in a colon cancer mouse model (35). Celecoxib, in combined with Lactobacillus acidophilus and Lactobacillus rhamnosus GG, dramatically decreased the number of aberrant crypt foci (ACF) and the expression of beta-catenin, NF-kB, and COX-2 in DMH-induced preclinical colon cancer Available reports indicate major probiotic protection mechanisms for chemotherapeutic toxicity including cell cycle maintenance and activation of tumor suppressor genes (36, 37), inactivation of proinflammatory cytokines, and inactivation of angiogenesis by inhibiting beta-catenin and NF-kB nuclear transport (36). Fewer studies are available to confirm the preventative usefulness of probiotics than for other types of cancer, including colorectal cancer. Several reports are accessible regarding the antitumor action of probiotics in relation to breast cancer. Daily intake of lactic acid could decrease the incidence of breast cancer in women (38). Also Radiation-related toxicity, like radiation-induced diarrhea, can be reduced by Bifidobacterium (41). Consequently, Bifidobacterium also improves the ability of chemotherapy and immunological therapy to treat cancer and decreases the side effects of these treatments, as well as radiation therapy (11). Interestingly, Bifidobacterium species improved immune function and Bifidobacterium therapy decreased melanoma growth, according to the findings (80). Researchers also found that in patients with head and neck cancer who received 70 Grays/35 fractions of radiation therapy and cisplatin treatment, L. brevis CD2 lozenges reduced oral mucositis (25). On the other hand, in a colon cancer rat model administered with 5-fluorouracil, Bifidobacterium infantis reduced the expression of proinflammatory cytokines (e.g., IL-6, IL-1, TNF-α) and contributed to minimizing mucositis (50). Additional study even found L. Gasseri orally reduced the cardiotoxicity of cisplatin. Compared to animals subjected to cisplatin and an antibiotic cocktail (vancomycin, ampicillin, and neomycin), the longevity of lung cancer rats exposed to cisplatin and Lactobacillus bacteria was much reduced (74). Likewise, an antibiotic cocktail reduced oxaliplatin's anti-cancer activity in E4 lymphomas and cisplatin's anti-cancer activity in colon carcinoma and E4 lymphomas (75). The absence of a reactive oxygen species (ROS) producing enzyme was also found to be the cause of the reduced anti-cancer activity in this research. Microflora may cause anti-cancer action by increasing the production of reactive oxygen species (ROS), according to research (75). Additionally, some bacteria play a significant role in the efficacy and toxicity of newly emerging immunotherapy medicines. Immunotherapy targeting checkpoint blockers was first licensed for the treatment of various cancers, and there are now a number of monoclonal antibodies target PD-1, PDL-1, and CTLA4 on the market. Monoclonal antibodies are regarded to be proper and effective tumor-growth inhibitors. PD-1 antibodies have been approved for the treatment of a variety of malignancies. Pembrolizumab and Nivolumab are PD-1 monoclonal antibodies, were first approved for the treatment of melanoma (78, 79). While this is going on, multiple PDL-1 antibodies have also been given the go-ahead to treat various malignancies. For instance, atezolizumab, avelumab, and durvalumab were authorized for use in the treatment of urothelial carcinoma, non-small cell lung cancer, and small cell lung cancer as well as bladder, non-small cell lung, breast, and small cell lung cancer. Additionally, the CTLA4 antibody therapy iplimumab has been licensed for the treatment of colorectal, renal cell, and melanoma cancer (78). In a melanoma mouse model, a mixture of PDL-1 antibody plus Bifidobacterium therapy stopped tumor growth (80). In advanced NSCLC and renal cell carcinoma, antibiotic exposure decreased the efficacy of PD-1 and PD-L1 antibody treatment (81). Wang et al. recently investigated the role of probiotics in lowering the incidence of colitis caused by CTLA4 blockade and discovered that vancomycin therapy increased the severity of the beginning of colitis in mice given dextran sodium sulfate (DSS) and anti–CTLA-4. Moreover, this study found that by down - regulating various proteins like IL-6, KC, and CFS3, the injection of a commonly available probiotic, Bifidobacterium, restored the vancomycin-induced microbiota unbalanced and prevented the autoimmune relating to anti treatment (65). In this study, the aim was to determine how probiotics prevent cancer cell proliferation, and it was found that probiotics reduce cancer cell proliferation by inhibiting growth factor signaling and promoting mitochondrial-mediated apoptosis. Furthermore, a study indicates that probiotics decrease the deleterious effects of chemo, immunological, and radiation therapy by reducing proinflammatory cytokines. As a result more clinical research is required to identify the strongest and appropriate probiotic strain for the development of adjuvant therapy to complement chemo, immune and radiation therapy.

Alzheimer’s Disease (AD) is a progressive neurodegenerative disorder that gradually leads to decline in memory and other intellectual functions, changes in personality and behavioral disturbances. Alois Alzheimer, for the first time, recognized that the double layer of Neurofibrillary tangles and senile plaques are key Neuropathological signs of Alzheimer's disease (5). These two degenerative layers are outside the nerve cells and around the cerebral vessels, which have Amyloid deposits in the center and dystrophic neurites and dendrites in the periphery, and their astrocytes and microglia are also activated (6). Their Amyloid core is mainly beta Amyloid peptide (Aβ), in transgenic animal models of Alzheimer's disease, it has been shown that intracellular Aβ affects synapse function and consequently learning and memory (7). Despite major progress made in our understanding of the underlying pathogenesis, the biological basis of AD is still not fully understood. As failures of compounds targeting Amyloid beta in clinical trials are repeatedly reported, the prevailing Amyloid cascade hypothesis is being questioned in terms of its causality. Other probable etiologies are also emerging, while new drugs are already urgently needed. Registered drug substances for treatment of Alzheimer’s disease are reviewed. They belong to the group of cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine, Tacrine or NMDA receptor antagonists (Memantine). They have also produced Nitromantannin, a molecule of Memantannin supplemented with a Nitro group. MW108 is a recently synthesized compound that acts as a p38 α MAP kinase inhibitor. And they can restore the basic function of the synapse and thus reduce the progression of cognitive dysfunction in Alzheimer's disease (34). In the last decade, two types of recombinant biological substances active in the production cycle of drugs for Alzheimer's patients have produced Monoclonal Antibodies that are produced against different parts of Amyloid beta, which prevent the formation or formation of Amyloid protein or tau. In addition, the most promising synthetic and biological drugs in development that are undergoing phase II or phase III clinical trials are presented. Some of the most popular dietary supplements derived from plants or animals include: Vitamin E in preventing the progression of Alzheimer's disease, the opinion of experts is controversial. (25). Ginkgo biloba leaf extract has been used for decades to improve memory and learning ability, and possibly to improve circulation. Despite the recognition of various mechanisms such as: release of nitric oxide (NO), endothelium relaxing factor (EDRF), prostaglandins (PGI2), antioxidant activity, in clinical studies there are still questions about the positive therapeutic effects of ginkgo extract in Alzheimer's disease. Epigallocatechin Gallate and resveratrol, the structure of both of these compounds, which can be pathological factors in the development of Alzheimer's disease, have close similarities. Epigallocatechin Gallate is thought to reduce the formation of toxic Amyloid oligomers. )27) Docosahexaenoic acid is found in fish oil. DHA is the most common Omega-3 Polyunsaturated fatty acid in the human brain. Studies show that they did not have a significant effect in the treatment of this disease, but in one study it was shown that if another additive called Eicosapentaenoic acid. (EPA) is added to DHA, this medicinal compound will have useful and significant effects in the early stages of Alzheimer's patients in its prevention and treatment. Curcumin is an effective substance found in turmeric root. It has an Anti-Inflammatory and preventive effect in preventing the development of colon cancer. Several hypotheses have been proposed regarding the action of Curcumin, that macrophages activated by Curcumin remove Amyloid plaques faster and to a greater extent. Curcumin is also thought to reduce inflammatory processes associated with glial cells and act as a systemic Anti-Inflammatory by inhibiting COX-2 Cyclooxygenase and reducing the expression of Pro-Inflammatory Cytokines, Epigallocatechin Gallate is also thought to reduce the formation of toxic Amyloid oligomers. (32). Drug interactions with drugs and drug interactions with supplements and food are very common in these patients and are associated with high risk. Extensive studies on drug interactions have shown that when the number of drugs used reaches 2, there is at least a 13% chance of unwanted side effects, or when it reaches 3 or more than 8, about 100% of patients will experience an unwanted drug side effects. Cholinesterase inhibitors including (Rivastigmin, Donezepil, Galantamine) prevent the hydrolysis of Acetylcholine. The increased effect of Acetylcholine causes bronchial constriction, increased secretions and bronchial spasm. They can also produce a vagotonic effect on the sinus and vestibular glands, therefore, treatment with cholinesterase inhibitors should be considered in patients with cardiac and respiratory dysfunction, a history of asthma or obstructive lung disease, peptic ulcer, Parkinson's disease, and seizure and tremor disorders. and patients with previous bradycardia or underlying cardiac conduction disorders should be treated with extreme caution (38-40-43-44-47). Before performing any imaging procedure that may be directly or indirectly injected into the spine, injections (Metrizamide, Iopamidol, Iohexol) can sometimes cause seizures, and if the patient is also taking drugs (Galantamine, Donepezil, Rivastigmine) at the same time uses, the risk may increase serious complications for the patient (55-57). Immunosuppressive drugs (Ozanimod and Siponimod) used to treat multiple sclerosis (RMS) with cholinesterase inhibitors such as (Galantamine, Donepezil, Rivastigmine) can increase the risk of irregular heart rhythms, which may be serious and potentially life-threatening. (60). Supplements containing (Ginkgo Biloba) with antibiotics such as (Ciprofloxacin and Levofloxacin, Ofloxacin) can cause seizures and danger. Taking Ginkgo Biloba together with Aspirin and warfarin can increase the risk of bleeding, and in patients with chronic hypertension, it is associated with an increased risk of unwanted complications. Also, with (Galantamine Donepezil, Rivastigmin) they cause an increased risk of seizures (61, 62). Also, supplements containing Epigallocatehin Gallate, such as green tea, can interact with Monoamine Oxidase inhibitors, oral contraceptives, Cimetidine, Verapamil, Fluconazole, Ciprofloxacin, Norfloxacin, and Enoxaparin, and also reduce the effects of Warfarin. Resveratrol, which is a Polyphenolic compound of Phthalaxin and its sources include red grapes, red raisins, red wine, red vinegar, raspberries, dark chocolate, etc. Its side effects during pregnancy, if taken as a supplement, can cause major problems in the fetal pancreas. The latest findings and results from Neuro Medicine research centers show that currently, according to the mechanism of action of these monoclonal antibody drugs, there is no expectation for a complete cure, and the reduction of Amyloid beta platelets significantly affects prevention and reduction. Cognitive, functional and behavioral abilities are not affected in Alzheimer patients. The possible interactions of these drugs with other drugs and supplements were investigated in the clinic, so that the unwanted side effects caused by them have a significant effect on the patient's treatment. According to the latest findings as well as the results of Neuro Medicine research centers, it can be concluded that currently, due to the mechanism of action of existing drugs and the use of various supplements, there is no expectation for a complete treatment of Alzheimer's disease, and their prescription can probably be Prevention and treatment or reduction of unwanted side effects are effective. Finding new drugs that can significantly reduce amyloid-beta platelets or affect the cognitive, functional and behavioral abilities of Alzheimer's patients is one of the important goals of researchers.

 Domestic violence, which is often called intimate partner violence, is usually directed at women and includes any physical, psychological, or sexual abuse. The most common form of violence against women worldwide is domestic violence or physical and emotional violence and sexual abuse of women by their emotional partners. Women are not the only victims of domestic violence. Sometimes they commit violence, but usually, the violence committed by women is more of the type of violence to defend themselves, on the other hand, the violence committed by men is mostly behaviors aimed at forced control. However, women are estimated to comprise 85% to 95% of victims. Youth exposed to parental violence are more likely to be victims of bullying or cyberbullying and are less likely to seek professional help. Various factors, including mental health issues such as antisocial and borderline personality disorders, anger and controlling behaviors, contextual factors such as childhood abuse experience, poverty, and economic crises, social factors, and lack of gender justice play a role in the occurrence of violence. Surveys conducted in different parts of the world show that ten to more than fifty percent of women have been mistreated by their husbands in some way, and nearly one-third to half of them have experienced physical abuse along with psychological violence. The economic and psychological burden of domestic violence is associated with a wide range of broad and negative consequences for society. From a societal perspective, the costs of being a victim of violence are extensive. These costs include costs related to increased health care use, such as emergency room and doctor visits, costs related to legal services, costs related to lost productivity and absenteeism, job instability, and reduced academic achievement. The existence of violence among family members leads to mental and emotional injuries; therefore, this research aimed to understand and analyze women's experience of domestic violence, the injuries caused by it, and their coping strategies during the Covid-19 era.

 Domestic violence against women is a phenomenon with broad concepts and dimensions. In this study, by using the phenomenological method, an attempt is made to obtain a deep understanding and recognition of the lived experiences of women who have been subjected to violence; the participants of this research are 12 women who had first-hand experience of the studied phenomenon. This number continued based on data saturation until we felt that new information would not be obtained, but to be sure, two more interviews were also conducted, but of course, no new data was obtained and the study reached theoretical saturation. The data were analyzed using the seven-step colaizzi method. Also, to validate the results, the findings were informed to the participants and explained to them, and their opinions were sought over the phone. This step was done by the main researcher, who all the participants confirmed the accuracy of the results and acknowledged that the results of this research fully reflected their feelings and experiences. In addition, all typed interviews and extracted concepts and coding were emailed to a distinguished professor at Kansas State University who has authored more than a hundred articles on the topic of intimate partner violence. This researcher has also conducted studies on violence in Iran. All levels were approved by him. Finally, the use of different processes led to the validity, transferability, verifiability, and reliability of the study. The research tools in this study included the following: During the interview, the conversations were recorded with the consent of the interviewees to check the information carefully. The data was collected through an in-depth and open-ended semi-structured interview. The researcher's preference was face-to-face interviews, but two of the interviews were conducted online at the request of the participants and the other ten interviews were conducted face-to-face at the counseling center following the protocols. All interviews were recorded and then transcribed verbatim in Persian; By asking general questions about the conditions and situations where the violence happened, one of the researchers tried to get the participants to enter into a conversation, and by gaining the trust of the participants and creating an empathetic dialogue, a suitable space for presenting honest answers. In this study, the duration of the interview varied from 45 minutes to 90 minutes. For coding and analyzing the data, the seven-step Claysey method was used.

 Data analysis (11 sub-themes and 2 main themes) shows the vulnerability caused by violence (psychological and personality vulnerability, children's vulnerability, couple's relationship vulnerability, spouse's family vulnerability, physical vulnerability) vulnerability of high-risk behaviors) and women's coping strategies to prevent more violence (searching for new hobbies, seeking help from family and relatives, seeking professional help, taking refuge in religion and spirituality, taking refuge in the law).

 Based on the experience of women, the results of this research showed that domestic violence, especially in stressful situations and crises, leaves a lot of vulnerability in different areas of the family system. Also, women have experienced different solutions to reduce violence. It seems that the professional help of counselors and psychiatrists based on psychological interventions and drug therapy has been more effective to control anger, and aggression and restore the relationship. Health officials must pay as much attention to mental and psychological issues as physical issues and psychological services are covered by insurance. Face-to-face interviews in pandemic conditions with masks and compliance with health protocols had limitations. Also, due to the norms of the society and customs as well as respect for modesty, it was not easy for the participants to talk about the violence along with the audio recording, especially since honor and keeping the behavioral problems of family members a secret is a cultural value. Domestic violence is related to all members of the family. It is better to research violence from the perspective of men and children to understand the needs, desires, and concerns of all family members. Also, the participants of this study were from the urban middle class, and there is a much more serious level of violence in the lower classes of society and marginalized people, which needs research.